Infective Endocarditis Pattern Among Pediatric Patients
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- Category: Vol. 77, June 2009
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Infective Endocarditis Pattern Among Pediatric Patients,NAGLAA ABD EL-RAHMAN MOSAAD
Abstract
Background: The second half of the 20th century has witnessed major changes in the epidemiology, bacteriology and clinical presentation of infective endocarditis (IE).
Aim of Work: To evaluate local patient characteristics, risk factors, clinical sequelae, microbiology, morbidity and mortality in paediatric patients with IE and to explore the use of trans-thoracic echocardiography (TTE) in the diagnosis of this illness.
Methods: Thirty patients with probable or definite diag-nosis of IE were prospectively enrolled in this study. Infective endocarditis was diagnosed according to the Duke criteria. Patients with rejected diagnosis of IE were excluded. Under-lying risk factors were sought. Initial evaluation and in-hospital follow-up included the documentation of vascular or immunological phenomena, morbidity and mortality.
Results: Of the 30 patients included, 24 cases (80%) had definite IE and 6 cases (20%) had possible IE. The studied patients had a mean age of 7.2±3.9 years with a male predom-inance (1.5:1). Rheumatic heart disease was present in 14 (46.7%), two of them had prosthetic valves (PVE). Fifteen had congenital heart disease (50%), one patient (3.3%) with no underlying cardiac lesion. Congestive heart failure and fever were detected in 100%, Glomerulonephritis without renal failure was observed in 2 patients (6.7%), embolic events in 8 cases (26.7%). Blood culture was positive in 27 cases (90%), with staph. aureus the most common isolates. TTE was definitive for vegetation in 25 cases (83.3%), possible in 4 cases including the two cases of PV and negative in one case. TEE required for the 2 PVE cases. The in-hospital mortality rate (medical and surgical) was 13.3%.
Conclusion: The clinical features of the present study almost have a similar pattern as the earlier studies. Increasing staph. aureus IE. The in-hospital morbidity and mortality are high. TTE remains the most appropriate first-line imaging investigation in the paediatric age group. TEE is indicated when the clinical suspicion of endocarditis is high and the TTE study is inconclusive.