A Brief Synopsis of

“HACEK” organisms
Michael Addidle
 HACEK ORGANISMS
 H-H. parainfluenzae
 A-Aggregatibacter
actinomycetecomitans
 - Aggregatibacter aphrophilus and
paraphrophilus.
 C-Cardiobacterium hominus
 E-Eikenella corrodens
 K-Kingella species
 What do HACEK organisms have
in common?
 Gram negative
 Commensals in oropharyngeal area
 Relatively fastidious
 Prefer CO2 enriched atmosphere
 All have a propensity to cause endocarditis, usually
secondary to rotten teeth or recent dental treatment or
combination of both.
• Endocarditis- long interval between first symptoms and
dx.
• Frequent embolisation
• May be large vegetations on left sided valves.
 Can all cause non-endocardial infections also.
 Haemophilus parainfluenzae
 H. aphrophilus and H.
paraphrophilus have moved
 Cause endocarditis more commonly
than H. influenzae but all
endocarditis caused by Haemophilus
is rare.
 A-Aggregatibacter
actinomycetecomitans
 Common cause of periodontitis
 Most endocarditis caused by this
bacteria have underlying heart
disease.
 Star-shaped colonies
 Cardiobacterium hominis
 In contrast to other members of the
group, almost exclusively associated
with endocarditis
 May also be commensal of GI tract
 Characteristic Gram stain: bulbous
ends and irregular staining. May
have a rosette pattern.

.
 Eikenella corrodens
 Oral commensal. May implicated in bite
infections.
 May cause infections at several different
sites within the body.
 Slightly yellow colonies after a few days
 Bleach like odour
 Pit into agar.
 Beta-lactamase strains are not infrequent.
Eikenella corrodens
 Kingella species
 K. kingae, K dentrificans, K.oralis, K.
potus
 Square ends, uneven decolorisation on
Gram stain.
 May be mildly haemolytic on blood agar
 Colonise pharynx of many children 6
months to 4 years.
 Common cause of septic arthritis in this
age group.
 Infections in adults usually in
immunocompromised.
 Injection of aspirate into BC media
improves detection rates.
Kingella species
Kingella species
 Molecular detection
 In modern blood culture systems,
HACEK organsims grow within 5
days.
 16s PCR
 Most useful for heart valves
 May also be useful for negative blood
cultures where high index of
suspicion.