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[Bacterial endocarditis in children]

J Normand1, A Bozio, J Etienne

  • 1Hôpital cardiovasculaire et pneumologique, BP Lyon-Montchat.

Archives Des Maladies Du Coeur Et Des Vaisseaux
|December 1, 1993
PubMed
Summary
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Pediatric infective endocarditis (IE) shows evolving trends, with congenital heart disease as a primary driver. While mortality decreases, more children experience severe sequelae, highlighting the need for advanced diagnostics and interventions.

Area of Science:

  • Cardiology
  • Pediatric Infectious Diseases
  • Medical Microbiology

Context:

  • Retrospective study of 69 pediatric infective endocarditis (IE) cases from 1971-1992.
  • Comparison of two decades (1971-1981 vs. 1982-1992) reveals changing IE natural history.
  • Focus on IE in children, particularly in France.

Purpose:

  • To analyze the changing trends and characteristics of pediatric infective endocarditis over two decades.
  • To identify key etiological factors, pathogens, diagnostic methods, and outcomes in pediatric IE.
  • To assess the impact of medical and surgical advancements on IE prognosis in children.

Summary:

  • Infective endocarditis in children has seen shifts, including increased incidence in younger children and a rise in congenital heart disease, often surgically treated.

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  • Mitral valve prolapse is a more frequent cause, with buccal and oto-rhino-laryngeal portals of entry. Streptococci and Staphylococci remain common, but uncommon pathogens are increasing.
  • Blood cultures are positive in 75% of cases. Echocardiography is crucial for diagnosis (64% detection of vegetations in Group II). Mortality decreased to 3%, but severe sequelae persist, with only 27% cured without complications.

    • Impact:

    • Highlights the evolving landscape of pediatric infective endocarditis, emphasizing congenital heart disease and mitral valve prolapse as major contributors.
    • Demonstrates the increasing role of advanced diagnostics like echocardiography and the challenges posed by uncommon pathogens.
    • Underscores the need for improved management strategies to reduce long-term sequelae, despite decreasing mortality rates in pediatric IE.