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Spectrum of infective endocarditis during infancy and childhood: 20-year review
J Fukushige1, H Igarashi, K Ueda
1Department of Pediatrics, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
Insights
Infective endocarditis (IE) in children is rare, with streptococci being a common cause. Echocardiography aids in identifying high-risk patients, but vegetation presence alone doesn't always necessitate surgery.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Echocardiography
Background:
- Infective endocarditis (IE) in children is uncommon but serious.
- Understanding the spectrum of IE in pediatric patients is crucial for timely diagnosis and management.
Purpose of the Study:
- To review the clinical characteristics, management, and outcomes of pediatric patients with infective endocarditis.
- To analyze the role of echocardiography in identifying high-risk patients.
Main Methods:
- Retrospective review of medical records of 29 pediatric patients with IE over 20 years.
- Analysis of patient demographics, clinical presentation, causative organisms, underlying heart conditions, treatment, and outcomes.
- Echocardiographic findings were correlated with clinical course and need for surgery.
Main Results:
- The mean age of onset was over 7 years, with 10% under 2 years.
- Streptococci were the most common pathogen (38%), and ventricular septal defect (VSD) was the most frequent underlying heart disease (66%).
- Echocardiography detected vegetations in 67% of evaluated patients, aiding in risk stratification, though not always dictating surgery.
Conclusions:
- Infective endocarditis in children presents a diverse clinical picture.
- While echocardiography is valuable for risk assessment, surgical intervention decisions require comprehensive clinical evaluation.
- Prompt diagnosis and appropriate management, including surgery when indicated, lead to favorable outcomes in pediatric IE.
Abstract:
The medical records of the 29 patients under 18 years of age with infective endocarditis (IE) seen over a 20-year period by our department were reviewed to provide an overview of the spectrum of IE during infancy and childhood. None of the 29 patients had had previous cardiovascular surgery. The mean age at onset of IE was 7 years 2 months; 3 patients (10%) were under 2 years of age at onset. One patient during the early years died following 4 months of treatment with various antibiotics. Three patients underwent urgent surgery, and 17 patients with healed IE had elective surgery. All of the 20 patients who were operated on survived. The remaining 8 were followed with medical treatment alone. Positive blood cultures were obtained from 24 (83%) patients, and streptococci were still commonly found (38%). Ventricular septal defect (VSD) accounted for 66% of underlying heart diseases and rheumatic heart diseases for 14%. Vegetations were detected in 12 (67%) of 18 patients observed by echocardiography. Among these 12 patients, 1 with VSD underwent urgent tricuspid valve replacement and VSD closure because of worsening congestive heart failure due to progressive tricuspid regurgitation. Echocardiography identifies patients at high risk with IE, though the presence of a vegetation on echocardiography does not necessarily of itself dictate surgical intervention.