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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

Information

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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