Haemophilus parainfluenzae endocarditis with multiple cerebral emboli in a pregnant woman with coronavirus

De Castro, Alicia; Abu-Hishmeh, Mohammad; El Husseini, Ibrahim; Paul, Lisa

Of note, one study involving 218 cases of IE in a single center has shown that as many as 47% of patient with IE have a neurological symptom as the presenting complaint, with up to 29% of patients developing neurological complaints within 1 week of the onset of other IE-related symptoms [12] . These neurologic manifestations include headaches, toxic encephalopathy, meningitis, brain abscess, TIA, embolic stroke, and intracranial hemorrhage. This underscores the importance of maintaining a high index of suspicion of IE in patients with HACEK bacteremia with neurological symptoms. Further, it has been shown that HACEK endocarditis has a significant propensity for neurologic complications such as stroke (25%), 56% of which are embolic, and 44% due to intracranial hemorrhage [7] . The presence of neurological complications in turn is associated with a higher morbidity and doubling of median length of stay in hospital [5] . It is significant to note that many patients develop neurologic complications before antimicrobials are started [13] [14] [15] , with as much as 12% of patients developing after initiating antimicrobials, the greatest risk associated with increasing vegetation size and mitral valve involvement [6] . However, the risk of embolic events to the central nervous system declines markedly after 2-3 weeks of initiation of antimicrobial therapy [4, 6] , falling to as low as <1.2 per 1000 patient-days after 2 weeks of therapy, declining further with time [5] . This further highlights the importance of recognizing HE and initiating appropriate antimicrobials, as infection control plays a critical role in preventing embolic events.