Endocarditis due to Streptococcus beta haemolyticus occurring during hospitalization in patients with acute rheumatic fever is not common and never reported in our institution.
A-ten-year-old-girl was admitted with palpitation and a previous history of swollen left knee. On admission she was alert, no fever, with a grade 3/6 pansystolic murmur at the apex spreading to the left axilla. No abnormalities seen on the left knee.Initial echocardiogram revealed moderate to severe mitral insufficiency with mildly dilated LA and LV. ECG showed a sinus rhythm with prolonged PR interval. Chest X ray did not show cardiomegaly. Blood test showed ESR 71 mm, CRP 96, ASTO 400 U.
She was given Benzathin Penicillin 1.2 million units for eradication / prohylaxis and asetosal. No IV line was inserted nor any intervention done. On day ten of hospitalization, fever developed, increasing gradually to 39 C. No significant changes of the pansystolic murmur was noted. On day 14 fever still persisted and a Janeway lesion seen on the sole. Another echocardiogram was carried out, which revealed two vegetations on the anterior and posterior leaflet of the mitral valve. Blood cultures from three different sites were taken over 24 hours, which later showed Streptoccus beta haemolyticus in every sample. In accordance with sensitivity test, Ceftriaxone was administered for 6 weeks. She was discharged in good condition.
We can conclude that in acute rheumatic fever, even after administration of benzathin penicillin in a hospitalized patient without any intervention, Streptococcus beta haemolyticus endocarditis may still be a threat.