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Eleven year review of infective endocarditis
A G Thekekara1, B Denham, D F Duff
1Our Lady's Hospital for Sick Children, Crumlin, Dublin.
Insights
Infective endocarditis (IE) in children is often linked to congenital heart disease (CHD), with Streptococcus viridans and Staphylococcus aureus as common causes. The study found a 25% mortality rate, highlighting the severity of pediatric IE.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
Background:
- Infective endocarditis (IE) is a serious infection affecting heart valves and inner lining.
- Congenital heart disease (CHD) is a significant predisposing factor in pediatric IE.
- Previous studies on pediatric IE epidemiology and outcomes are limited.
Purpose of the Study:
- To describe the clinical characteristics, causative agents, and outcomes of infective endocarditis in children.
- To identify risk factors and common pathogens associated with pediatric IE.
- To evaluate treatment strategies and survival rates for children with IE.
Main Methods:
- Retrospective case series of 20 children treated for IE between 1980 and 1990.
- Data collection included patient demographics, underlying cardiac conditions, causative microorganisms, diagnostic methods (echocardiography), treatment (antibiotics, surgery), and outcomes (survival, follow-up).
Main Results:
- Congenital heart disease (CHD) was the most common underlying condition (18/20), particularly acyanotic heart disease (13/20) like ventricular septal defects.
- Streptococcus viridans (50%) and Staphylococcus aureus (35%) were the most frequent pathogens.
- Echocardiography detected vegetations in 63% of cases. Overall mortality was 25%, with 75% survival at a mean follow-up of 22.6 months.
Conclusions:
- Pediatric infective endocarditis, especially in children with CHD, carries a significant mortality risk.
- Prompt diagnosis and appropriate antibiotic therapy are crucial for improving outcomes.
- Further research into specific management strategies for pediatric IE is warranted.
Abstract:
Twenty children were treated for infective endocarditis (IE) at Our Lady's Hospital for Sick Children during an eleven year period from January 1980 to December 1990. One child had I.E. on two occasions due to different microorganisms. Two had Down syndrome. Congenital heart disease (CHD) was the single most common underlying condition and there was none with rheumatic heart disease. Two had no clinically recognised cardiac anomaly. 13/20 (65%) had acyanotic heart disease and 5/20 (25%) had cyanotic CHD. Among the acyanotic group, ventricular septal defect was most common (6/13); followed by aortic lesions (4/13). There was one case each of coarctation of aorta, patent ductus arteriosus and interrupted aortic arch. Transposition of the great arteries was most common among the cyanotic group (3/5). Four children in the cyanotic group had systemic to pulmonary artery shunts; Blalock Taussig (2), Waterston (1), and aortopulmonary (1). Infection was caused by Streptococcus viridans in 10/20 (50%) and Staphylococcus aureus in 7/20 (35%). Kingella Kingae, Neisseria meningitidis and Streptococcus faecalis were the pathogens in the remainder (15%). Vegetations were detected by echocardiography in 12/19 (63%). The mean duration of antibiotic treatment was 5 weeks (1 day-18 weeks). Surgical intervention was necessary in 4 children (20%). Fifteen children (75%) survived and the mean follow up period was 22.6 months (15 days-6 1/2 years). The overall mortality was 25%.