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Infectious endocarditis in children: changing pattern in a developing country

Published online by Cambridge University Press:  19 August 2008

Mukti Sharma ,
Anita Saxena ,
Shyam S Kothari ,
C.B. Subash ,
D.M. Reddy ,
P. Venugopal  and
H.S. Wasir
Mukti Sharma
Affiliation:
From the Department of Cardiology and Cardiovascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, Ansari nagar, New Delhi, India.
Anita Saxena*
Affiliation:
From the Department of Cardiology and Cardiovascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, Ansari nagar, New Delhi, India.
Shyam S Kothari
Affiliation:
From the Department of Cardiology and Cardiovascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, Ansari nagar, New Delhi, India.
C.B. Subash
Affiliation:
From the Department of Cardiology and Cardiovascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, Ansari nagar, New Delhi, India.
D.M. Reddy
Affiliation:
From the Department of Cardiology and Cardiovascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, Ansari nagar, New Delhi, India.
P. Venugopal
Affiliation:
From the Department of Cardiology and Cardiovascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, Ansari nagar, New Delhi, India.
H.S. Wasir
Affiliation:
From the Department of Cardiology and Cardiovascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, Ansari nagar, New Delhi, India.
*
Dr Anita Saxena DM, Department of Cardiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India - 110029. Fax:91-011-6862663
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Abstract

Background

There is a reported change in the profile of infectious endocarditis and a reduction in its mortality in the developed world. We present our experience of infectious endocarditis in children seen in the last 5 years in the developing world.

Methods

Records of 43 consecutive children with infectious endocarditis admitted to this centre were analysed retrospectively. Diagnosis was based on presence of any two of the following: fever with no extracardiac features; vegetations on echocardiography; Positive blood culture with no extracardiac focus; and embolic episodes.

Results

The age at diagnosis ranged from 40 days to 16 years (mean 8.5 years); Of the patients 3 were under 2 years of age; 28 were males and 15 females. Congenital heart disease was the underlying cause in 32 (74%), and rheumatic heart disease in 11 children. All except the youngest presented with fever. Blood cultures were positive in 16 (37%). Vegetations were detected by cross-sectional echocardiography in all except 1 child. After treatment 31 (72%) responded to a combination of penicillin and aminoglycoside. Emergency surgery was undertaken in 9 (21%). Three patients (7%) died, and all of these had fungal endocarditis.

Conclusions

Blood cultures give a low yield, but cross-sectional echocardiography is a sensitive tool in the diagnosis of infectious endocarditis. Most children respond to penicillin and an aminoglycoside. An aggressive surgical approach in complicated cases lowers the mortality.

Keywords

infectious endocarditiscongenital heart diseaserheumatic heart disease
Type
Original Articles
Information
Cardiology in the Young , Volume 7 , Issue 2 , April 1997 , pp. 201 - 206
Copyright
Copyright © Cambridge University Press 1997

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References

1.Courlee, F, Carceller, A, Deschamps, L, Kratz, C, LaPointe, J, Davignon, A. The evolving pattern of pediatric endocarditis from 1960 to 1985. Can J Cardiol 1990; 6: 164–170.Google Scholar
2.Kaplan, EL. infectious endocarditis in the pediatric age group: and overview. In: Kaplan, EL, Taranta, AV, (eds). An american heart association symposium. Dallas, American heart association. Infect endocard 1977: 51–54.Google Scholar
3.Awadallah, SM, Kavey, RW, Byrum, CJ, Smith, FC, Kveseles, DA, Blackman, MS. The changing pattern of infective endocarditis in childhood. Am J Cardiol 1991; 68: 90–94.Google Scholar
4.Choudhury, R, Grover, A, Verma, J, Khattri, HN, Anand, IS, Bidwai, PS, Wahi, PL, Sapru, RP. Active infectious endocarditis observed in an Indian hospital 1981–1991. Am J Cardiol 1992; 70: 1453–1458.Google Scholar
5.Kothari, SS, Sudan, D, Saxena, A. Mitral annular abscess in salmonella endocarditis: resolution with medical therapy. Indian Heart J 1995; 47: 263–264.Google ScholarPubMed
6.Zuberbuhler, JR, Neches, WH, Park, SC. Infectious endocarditis-an experience spanning three decades. Cardiol Young 1994; 4: 244–251.CrossRefGoogle Scholar
7.Hansen, D, Schmiegelelow, K, Jacobsen, JR, Bacterial endocaridtis in children: Trends in its diagnosis, course and prognosis. Pediatr Cardiol 1992; 13: 198–203.CrossRefGoogle ScholarPubMed
8.Geva, P, Frand, M. infectious endocarditis in children and congenital heart diease: the changing spectrum. 1965–85. Eur Heart J 1988; 9: 1244–1249.Google Scholar
9.Bloominthal, S, Griffiths, SP, Morgan, BC. Bacterial endocarditis in children with heart disease: a review based on the literature and experience with 58 cases. Pediatrics 1960; 26: 993–1017.CrossRefGoogle Scholar
10.Millard, DD, Schulman, ST. The changing spectrum of neonatal endocarditis. Clin Perinatol 1988; 15: 587–608.CrossRefGoogle ScholarPubMed
11.Mendelsohn, G, Hutchins, GM. infectious endocarditis during the first decade of life: an autopsy review of 33 cases. Am J Dis Child 1979; 133: 619–622.Google Scholar
12.Dhawan, A, Grover, A, Marwaha, RK, Khatri, HN, Anand, IS, Kumar, L, Walia, BN, Bidwai, PS. infectious endocarditis in children: profile in a developing country. Ann Trop Pediatr 1993; 13(2):189–194.Google Scholar
13.O'Brien, JT, Geiser, EA. infectious endocarditis and echocar diography. Am Heart J 1984; 106: 386–394.Google Scholar
14.Aggarwal, R, Behel, VK, Malaviya, AN. Changing spectrum of clinical and laboratory profile of infectious endocarditis. J Assoc Physicians India 1992; 40: 721–723.Google Scholar
15.Cannadey, PB, Stanford, JP. Negative blood cultures in infectious endocarditis: a review. South Med J 1976; 69: 1420–1424.CrossRefGoogle Scholar
16.Pesanty, EL, Smith, IN. infectious endocarditis with negative blood cultures: an analysis of 52 cases. Am J Med 1979; 66: 43–50.CrossRefGoogle Scholar
17.Sox, HC, Liang, MH. The erythrocytic sedimentation rate, guidelines for rational use. Ann Int Med 1986; 104: 515–523.Google Scholar
18.Bisno, AL, Dismukes, WE, Durack, DT, Kaplan, EL, Karchmer, AW, Kaye, D, Rahimtoola, SH, Sande, MA, Sanford, JP, Watanakunakorn, C. Antimircobial treatment of infective endocarditis due to viridans streptococci, enterococci and staphylocci. JAMA 1989; 261: 1471–1477.Google Scholar
19.Alsip, SG, Blackstone, EH, Kurklin, JW, Cobbs, CG. Indications for cardiac surgery in patients with active infectious endocarditis. Am J Med 1985; 78 (supp) 6B: 138–148.Google Scholar
20.Mugge, A, Daniel, WG, Frank, G, Lichtlen, PR. Echocardiography in infectious endocarditis: the assessment of prognostic implications of vegeration size derermined by the transthorasic and the transoesophageal approach. J Am Coll Cardiol 1989; 14: 631–638.Google Scholar
21.Steckelberg, JM, Murphy, JG, Ballard, D, Bailey, K, Tajik, AJ, Taliercio, CP, Giuliani, ER, Wilson, WR. Emboli in infective endocarditis: the prognostic value of echocardiography. An Intern Med 1991; 114: 635–640.Google Scholar
22.Saiman, L, Prince, A, Gersony, WM. Pediatric infective endocarditis in the modern era. J Pediatr 1993; 122(6): 847–853.CrossRefGoogle ScholarPubMed