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Endocarditis with a large thrombus complicating a central venous access device.
P Venugopalan1, A Louon, F O Akinbami
1Department of Child Health, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman. gopalax@gto.net.om
Annals of Tropical Paediatrics
|December 22, 1999
Summary
A pediatric patient on total parenteral nutrition developed an infected thrombus and endocarditis. Conservative management led to vegetation resolution, with the central venous access device remaining in situ.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Total parenteral nutrition (TPN) is crucial for infants with gastrointestinal dysfunction.
- Central venous access devices (CVADs) are essential for TPN delivery but carry infection risks.
- Infected thrombus and endocarditis are serious complications in patients with CVADs.
Observation:
- A 12-month-old infant receiving TPN via a CVAD presented with clinical signs of infection.
- Diagnostic workup revealed an infected thrombus associated with the CVAD and infective endocarditis.
- The patient's clinical condition was monitored closely.
Findings:
- Conservative management, including appropriate antimicrobial therapy, was initiated.
- Serial echocardiography demonstrated resolution of the vegetation.
- The infected thrombus also showed signs of resolution without device removal.
Implications:
- This case highlights the possibility of successful conservative management for infected thrombus and endocarditis in pediatric patients on TPN.
- Preserving the CVAD may be feasible in select cases, avoiding risks associated with deviceリplacement.
- Further research is warranted to establish guidelines for managing such complex infections in vulnerable pediatric populations.