Infectious endocarditis in children: changing pattern in a developing country

Abstract

AbstractBackgroundThere 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.MethodsRecords 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.ResultsThe 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.ConclusionsBlood 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.