Case Presentation:

A 20‐year‐old man with a history of congenital long QT syndrome status post–automatic implantable cardiac defibrillator (AICD), intravenous drug abuse, and hepatitis C presented with 1 week of low‐grade fever and myalgia. Last drug use was 1 day ago. The patient had no cough, rash, diarrhea, or dysuria. Vital signs were: temperature 37.9°C, blood pressure 110/66, respiratory rate 18/ min, and heart rate 80/min. Physical exam was normal except for needle marks on the upper extremities. But there was no sign of skin infection or cardiac murmur. A complete blood count, basic metabolic panel, liver function tests, uri‐nalysis, electrocardiogram, and chest X‐ray were all normal. Blood cultures grew Haemophilus parainfluenzae at 68 hours. Transthoraic echocardiogram revealed extensive endocarditis involving AICD leads and the tricuspid valve. A detailed social history revealed that he licked needles prior to injecting heroin. The AICD and leads were explanted. He was treated with 6 weeks of ceftriaxone.

Discussion:

Haemo‐philus parainfluenzae is a member of the HACEK organisms, a group of fastidious gram‐negative bacilli. Although it is responsible for 0.5%–1% of native ‐valve endocarditis, H. parainfluenzae is an extremely rare cause of cardiac device infection (CDI). Common organisms associated with CDI are: Staphylococcus aureus, coagulase‐negative staphylococci, and enteric gram‐negative bacilli. H. parainfluenzae is part of human oral and upper respiratory flora. The oral cavity was the likely source in our patient given the history of needle licking. Historically, the HACEK group was thought to be difficult to grow, and prolonged incubation of blood cultures was recommended. Some recent studies have shown that with modern culture techniques, prolonged incubation is not necessary. This was found to be true in our patient also; his blood cultures turned positive at 68 hours (2.6 days). Haemo‐philus parainfluenzae endocarditis is associated with a significant risk of septic embolization if not treated in time.

Conclusions:

This case report highlights that H. parainfluen‐zae(a HACEK organism) can cause cardiac device infection. It also emphasizes obtaining details of drug abuse practices, because knowledge of the licking of needles was critical in establishing the source of the bacteremia.

Disclosures:

O. Pappa ‐ none; R. D. Khehra ‐ none; S. Sidhu ‐ none