Sudden infant death due to Lactococcal infective endocarditis

doi:10.1016/j.legalmed.2015.07.013

Legal Medicine

Volume 19, March 2016, Pages 107-111

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Highlights

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We experienced a case of sudden infantile death due to Lactococcal infective endocarditis.
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This is the first report of infantile fatal Lactococcal endocarditis according to our knowledge.
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Clinician should suspect infective endocarditis in baby, even if it had no heart trouble in the past.
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Forensic pathologist is expected to collect and analyze case of rare disease for its prevention.

Abstract

Infective endocarditis (IE) of infants is rare, most of which occur associated with congenital heart disease or its cardiac surgery. We experienced a case of sudden death of a four-month-old male infant without congenital heart disease. It was elucidated by postmortem examination that the dead had suffered severe IE, which led him to death. In the microbiological genetic analysis using histological section, the pathogen causing inflammation in the present case was identified as Lactococcus lactis subspecies, although Staphylococci have been reported to be common and important one. Previously reported infectious diseases by Lactococcus lactis subspecies were all adult cases and this is the first report of an infantile death due to Lactococcal IE according to our knowledge. Any fatal disease may be included in sudden death cases targeted for forensic autopsy, even if it is rare. It is expected for forensic pathologists that they note such case and share each experience among themselves and other medical fields to develop a strategy for prevention.

Introduction

Infective endocarditis (IE) of children is much less than that of adults. It has been reported that most of the pediatric IE patients suffer congenital heart disease, the state of its surgery, or other preexisting heart disease, and infantile IE without congenital heart disease or preexisting heart disease is to be extremely rare [1], [2], [3], [4], [5], [6]. From the aspect of etiologic agent, Lactococcal IE is very rare and only few adult cases were reported so far [7], [8], [9], while most frequent one is Staphylococcus species [1], [2], [4], [5], [6], [10], [11], [12].

The hospitalization rate for IE of children was variable among published series [1], [2], [3], [4], [5]. Day et al. described that infants had formed one of the bimodal peaks (<1 year, n = 545, 36.8%) in the series of 1480 IE cases under 21 years of age [1], while Ishiwada et al. showed that infants and neonates were only 16 (8.5%) of 188 IE children [5].

In this article, we described a case of a four-month-old male infant without congenital heart disease as well as any preexisting heart trouble who had suddenly died due to Lactococcal IE just before hospitalization.

Section snippets

Case history

The patient was four-month-old male infant. He was born healthily, with 48 cm height and 2982 g body weight, without any physical abnormality at 37 weeks of pregnancy. He was the second child of the parents, and his brother had been grown healthy. The baby had been fed only with mother’s milk and grew well. He took medical examination monthly and was vaccinated regularly. The last medical check was taken 10 days before death and he had no problem.

On the day of the death, his mother took the baby to

Autopsy findings

The deceased was well developed infant with 65 cm height and 6.5 kg body weight. Neither facial congestion nor conjunctival petechiae were observed. No injury was found at both external and internal examination. Exudates in left thoracic, right thoracic and abdominal cavities were 20 ml, 30 ml and 100 ml, respectively. The heart was 30 g in weight, without anomaly, such as ventricular and atrial septal defect, patent ductus arteriosus, patent foramen ovale and so on. No gross aneurysm of coronary

Laboratory examinations

Antigens of Influenza virus (A and B), RS virus and Adenovirus were not detected from the surface of pharyngeal and respiratory mucosa by immunological examination. Titer of anti-viral antibodies in the serum for Adenovirus, Parainfluenza virus (types 1–3), RS virus, Coxsackie virus (group A type 9, group B types 1–6), Mumps virus, Measles virus, Herpes zoster virus, Herpes simplex virus, Cytomegalovirus, and Echo virus (types 5, 11, 16, 18, 19, 22 and 24) were all within normal limits. In the

Discussion

There are some reports that mortality due to child IE has been decreased [3], [6]. However, mortality rate of infantile IE without congenital or preexisting heart disease as extremely rare event is to be higher than that of child one [1], [2], [3], [4], [5], [6]. In the present case the dead was a four-month-old infant and had neither congenital nor preexisting heart disease, but the cause of death was diagnosed as IE.

For the diagnosis of definite IE, pathological criteria in the modified Duke

Conclusion

We experienced a case of sudden infant death form IE caused by L. lactis subspecies who had no congenital heart disease and previous heart trouble. Clinicians should suspect IE and observe his course carefully after hospitalization, when newly occurring fever and heart murmur are noticed, especially in case that the patient is a baby. It is also expected for forensic pathologists that they note Lactococcal IE as a not ignorable infectious disease among infants, they are familiar with the

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Citation Excerpt :
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Sudden infant death due to Lactococcal infective endocarditis

Highlights

Abstract

Introduction

Section snippets

Case history

Autopsy findings

Laboratory examinations

Discussion

Conclusion

Conflict of interest

Mayo Clin. Proc.

Diagn. Microbiol. Infect. Dis.

Characteristics of children hospitalized with infective endocarditis

Circulation

Frequency of infective endocarditis among infants and children with Staphylococcus aureus bacteremia

Pediatrics

Infective endocarditis in previously healthy children with structurally normal hearts

Pediatr. Cardiol.

Infective endocarditis in congenital heart disease: Japanese national collaboration study

Heart

Causative organism influences clinical profile and outcome of infective endocarditis in pediatric patients and adults with congenital heart disease

Circ. J.

Diagnosis of bacterial endocarditis caused by Streptococcus lactis and assisted by immunoblotting of serum antibodies

J. Infect.

Infective endocarditis complicated by intracerebral hemorrhage due to Lactococcus lactis subspecies cremoris

Infection

The changing face of infective endocarditis

Heart

Infective endocarditis in congenital heart disease: a frequent community-acquired complication

Infection