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Infective endocarditis in children: profile in a developing country
A Dhawan1, A Grover, R K Marwaha
1Department of Paediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Infective endocarditis in Indian children presents differently than in Western countries, often occurring in those with underlying heart conditions or preceding infections. This study highlights a high mortality rate in pediatric patients, emphasizing the need for tailored interventions.
Area of Science:
- Pediatrics
- Infectious Diseases
- Cardiology
Background:
- Infective endocarditis (IE) is a serious infection affecting heart valves and inner lining.
- Understanding the specific profile of IE in pediatric populations in developing countries is crucial for effective management.
- Previous studies have primarily focused on IE in adults or in developed nations.
Purpose of the Study:
- To investigate the clinical profile and outcomes of infective endocarditis in Indian children under 16 years of age.
- To compare the characteristics of pediatric IE in India with those reported in Europe and the USA.
- To identify risk factors and mortality predictors in this specific demographic.
Main Methods:
- A retrospective study was conducted on 37 pediatric patients diagnosed with infective endocarditis between January 1984 and December 1990.
- Data collected included patient demographics, underlying cardiac conditions, preceding illnesses, microbiological findings, and treatment outcomes.
- Statistical analysis was performed to determine the prevalence of different etiological agents and associated conditions.
Main Results:
- The study included 37 patients (26 boys, 11 girls) aged 2-16 years.
- A significant proportion had underlying heart disease: 48.6% congenital, 35.1% rheumatic.
- Staphylococcus aureus and Streptococcus viridans were the most common pathogens identified; blood cultures were positive in only 43.2% of cases.
- The mortality rate was high at 43.2%, attributed to hemodynamic compromise, sepsis, and limited surgical options.
Conclusions:
- Pediatric infective endocarditis in India exhibits a distinct profile compared to Western countries, with a notable prevalence of underlying heart disease.
- The high mortality rate underscores the challenges in managing IE in developing nations, necessitating improved diagnostic and therapeutic strategies.
- Early recognition and prompt intervention are critical for improving outcomes in children with infective endocarditis.
Abstract:
With the object of studying the profile of infective endocarditis in Indian children younger than 16 years of age, a retrospective study of 37 patients with infective endocarditis admitted to this hospital between January 1984 and December 1990 was carried out. There were 26 boys and 11 girls (aged 2-16 years (mean (SD) 10.3 (3.8)). Eighteen (48.6%) patients had underlying congenital heart disease, 13 (35.1%) had associated rheumatic heart disease whilst the remaining six had no pre-existing heart disease. All six patients with a normal heart and infective endocarditis had preceding extra-cardiac bacterial illnesses (epididymitis and orchitis in one, pneumonia in five). Blood cultures were positive in only 16 (43.2%): Staphylococcus aureus was grown in nine, Streptococcus viridans in six and Candida albicans in one. Sixteen (43.2%) of the 37 patients died owing to worsening cardiovascular haemodynamics, uncontrolled septicaemia and our inability to offer emergency surgery. The profile of infective endocarditis in developing countries is different from that in Europe and the United States of America, and the disease carries a very high mortality.