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[Infectious endocarditis in children]
Insights
Pediatric infective endocarditis is a growing concern, often linked to rheumatic or congenital heart disease. Delays in diagnosis and complications like embolism contribute to a high mortality rate, emphasizing the need for timely intervention.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Cardiovascular Surgery
Context:
- Advances in congenital heart disease surgery increase adult survival.
- Infective endocarditis in childhood is a rising clinical challenge.
- Study conducted at INC pediatric cardiology ward (1977-1981).
Purpose:
- To analyze the clinical characteristics, complications, and outcomes of infective endocarditis in pediatric patients.
- To identify common underlying conditions and etiological agents.
- To evaluate treatment efficacy in cases with negative blood cultures.
Summary:
- 32 pediatric cases of infective endocarditis studied, with a male predominance (62.5%).
- Common underlying conditions included rheumatic heart disease (40.7%), congenital heart disease (15.6%), and postoperative states (43.7%).
- Average diagnostic delay was 43 days; Staphylococcus and Streptococcus were most frequent isolates. Peripheral and pulmonary embolism occurred in 34.4% of cases. Antibiotic combinations (ampicillin/oxacillin + aminoglycosides) showed success in negative blood culture cases. Mortality rate was 53%.
Impact:
- Highlights the significant morbidity and mortality associated with pediatric infective endocarditis.
- Underscores the importance of early diagnosis and management in high-risk pediatric populations.
- Provides insights into effective antibiotic strategies for culture-negative endocarditis.
Abstract:
he recent advances in surgical treatment of congenital heart disease, permits the survival of those cases to adult life. Infective endocarditis in the childhood is becoming increasingly important. We studied 32 cases in the pediatric cardiology ward at the INC between 1977 and 1981. There was a male predominance of 62.5%. Rheumatic heart disease (40.7%), congenital heart disease (15.6%) and postoperative cases (43.7%) were the underlying conditions. There was an average time of 43 days delay from the first symptom to diagnosis. Blood cultures were taken in 29 cases (90.6%). Only half of them were positive. Staphylococcus and streptococcus were the commonest isolates. Peripheral and pulmonary embolism (11 cases-34.4%) were the most frequent complications. In those cases with negative blood culture the most successful antibiotic combination was ampicillin or oxacillin plus aminoglucosides (56%). There were 17 deaths (53%).