Pediatric Infection and Vaccine

The Korean Society of Pediatric Infectious Diseases (대한소아감염학회)
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Infective Endocarditis Caused by Methicillin-Resistant Staphylococcus aureus Combined with Meningitis

수막염과 동반된 메티실린내성 황색포도알균에 의한 감염성 심내막염 1예

  • Na, Kyung Won (Department of Pediatrics, Eulji University Hospital, Eulji University School of Medicine) ;
  • Kim, Jon Soo (Department of Pediatrics, Eulji University Hospital, Eulji University School of Medicine) ;
  • Kim, Hyun Jung (Department of Pediatrics, Eulji University Hospital, Eulji University School of Medicine)
  • 나경원 (을지대학교 의과대학 대전을지대학병원 소아청소년과) ;
  • 김존수 (을지대학교 의과대학 대전을지대학병원 소아청소년과) ;
  • 김현정 (을지대학교 의과대학 대전을지대학병원 소아청소년과)
  • Received : 2016.06.12
  • Accepted : 2016.09.09
  • Published : 2016.12.25
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Abstract

Infective endocarditis (IE) caused by methicillin-resistant Staphylococcus aureus (MRSA) has become a worldwide concern. We present a case of a 12-year-old child with IE of the native mitral valve due to MRSA infection after an invasive dental procedure. Based on the clinical symptoms and the presence of cerebrospinal fluid pleocytosis, the patient was initially diagnosed with presumed bacterial meningitis and treated with empiric antibiotics. On the third day of hospitalization, MRSA was cultured from the initial blood samples and vegetation was observed on the mitral valve during an echocardiogram, findings which are compatible with a diagnosis of IE. The revised guidelines for antibiotic prophylaxis for the prevention of IE advise that IE prophylaxis for dental procedures is reasonable only for patients with underlying cardiac conditions, who are at the highest risk of adverse outcomes from IE. However, in this case, the patient had no high risk factors indicative of IE prophylaxis, except for mitral valve prolapse. She had no recurrence of IE over a follow-up period of 12 months.

최근 전 세계적으로 메티실린내성 황색포도알균(methicillin-resistant Staphylococcus aureus [MRSA])에 의한 감염성 심내막염의 빈도가 증가하는 추세이다. 저자들은 12세 여아가 침습적 치과 치료 이후에 발생한 MRSA에 의한 감염성 심내막염 1예를 경험하였기에 보고하는 바이다. 환아가 경부강직을 나타내어 시행한 뇌척수액 검사상 세포 증가증 소견이 보였고 세균성 수막염을 의심하여 항생제 치료를 시작하였으며, 입원 3병일째 혈액 배양검사에서 MRSA가 검출되었다. 심장 초음파상 승모판막의 전엽에 붙어있는 증식조직이 증명되어 항생제 치료 후 호전되어 퇴원하였다. 개정된 심내막염 예방을 위한 가이드라인에서는 오직 고위험군에서만 치과 처치 전에 예방적 항생제 요법을 권장하고 있다. 본 증례는 승모판 탈출증 이외에 고위험군이 없었던 환아에서 잇몸의 출혈을 유발하는 치과 치료를 받은 이후에 발병한 감염성 심내막염의 경우로서, 이후 12개월간 감염성 심내막염의 재발은 없었다.

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