Cook Inlet beluga whale Delphinapterus leucas with valvular endocarditis, encephalitis, rhabdomyolysis, heavy parasitism and fungal dermatitis

This is a case report of a Cook Inlet beluga whale Delphinapterus leucas found dead stranded on September 28, 2020 in Turnagain Arm, Alaska. This subadult male had valvular endocarditis, encephalitis, rhabdomyolysis, myoglobinuric nephropathy, severe parasitism and fungal dermatitis. Erysipelothrix rhusiopathiae was detected in the heart lesion, eye and external swabs. The level of infection and parasitism in this individual is markedly higher than what has been found in other Cook Inlet belugas, suggesting immunosuppression.

Diagnostic work-up and current management strategies for infective endocarditis in the pediatric population

Infective endocarditis (IE) remains a serious disease that is associated with significant morbidity and mortality, and despite the significant advances that have been made in understanding the disease process in past decades, its incidence appears to be on the rise recently. Endocarditis in children is no longer a rare occurrence. This appeared to be related to a combination of the improved survival of children with congenital heart diseases (CHDs), increase use of intracardiac protheses, and catheter-related interventions. The American Heart Association (AHA) 2007 guidelines reduced the recommendations for use of prophylactic antibiotics in those with CHDs which occurred despite the noticeable increase in endocarditis incidence around that time. In general, the recommendations for managing children with IE are derived from the adults' guidelines, and the evidence-base is lacking in many clinical scenarios. Understanding the epidemiology, clinical presentations, microbiology, and outcomes of different management strategies for endocarditis is needed to have a clear and optimal plan for these children. In the current narrative review, we discuss IE in the pediatric population in terms of etiology, predisposing factors, and different treatment strategies for this unique population.