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Fatal Staphylococcus Aureus Endocarditis Misdiagnosed as Multisystem Inflammatory Syndrome in Children. Pediatr Infect Dis J 2022; 41:e58-e59. [PMID: 34840313 DOI: 10.1097/inf.0000000000003417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We present a case of a 10-year-old male with Staphylococcus aureus mitral endocarditis who was initially misdiagnosed with multisystem inflammatory syndrome associated with coronavirus disease 2019, with eventual fatal outcome due to brain hemorrhage after cardiac intervention. Our case differs from recent studies, in which microbleeds did not increase the risk of hemorrhagic stroke or global mortality risk.
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2
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Dandapat S, Guerrero WR, Ortega-Gutierrez S. Acute StrokeTreatment in Children: Are Adult Guidelines Applicable? Curr Treat Options Neurol 2022; 24:41-54. [PMID: 35509674 PMCID: PMC9060549 DOI: 10.1007/s11940-022-00707-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Purpose of this Review This article provides an overview into acute treatments in stroke which are widely studied and available for adults and their applicability in the pediatric population. Recent Findings Arterial ischemic stroke is an important cause of morbidity and mortality in the pediatric population. Neurological deficits and etiologies are age-dependent and more challenging to diagnose than in the adult population. Advancements in imaging and treatment modalities including increased treatment windows in acute stroke have led to improvement in the diagnosis and management of pediatric arterial ischemic disease. Accordingly, hyperacute treatments, such as endovascular therapy, are becoming increasingly available in an attempt to improve outcomes in children. Summary Significant scientific and technological advances have transformed the hyperacute treatment of stroke in the recent years, allowing for improvement in the diagnosis and treatment of cerebrovascular pathologies in children. Optimization in the approach, and validation of existing stroke pathways/protocols is expected to further advance acute stroke therapy in pediatric patient care. Given that the lifelong individual, family, and societal burden of acute stroke is likely to be greater than in adults because infants and children surviving stroke live more years with disability, we must be knowledgeable about this pathology and the medical and therapeutic options available for this unique population as detailed in this review.
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Affiliation(s)
- Sudeepta Dandapat
- Department of Neurosciences, Aurora Neuroscience Innovation Institute, St.Luke’s Hospital, Milwaukee, WI
| | - Waldo R. Guerrero
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL
| | - Santiago Ortega-Gutierrez
- Department of Neurology, Radiology and Neurosurgery, University of Iowa Comprehensive Stroke Center, Iowa City, IA
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AlBassri T, Sheikho M, Chaikhouni F, Al Habshan F, Kabbani MS. Neurological complications in children with infective endocarditis: Incidence, risk factors, and outcome: A 10-year single-center experience. Int J Pediatr Adolesc Med 2021; 8:198-202. [PMID: 34350336 PMCID: PMC8319676 DOI: 10.1016/j.ijpam.2021.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/26/2020] [Accepted: 02/14/2021] [Indexed: 04/13/2023]
Abstract
BACKGROUND AND OBJECTIVE Despite improvement in medical management, infective endocarditis (IE) remains a serious disease that may affect children with and without preexisting cardiac conditions with significant morbidity and mortality. Neurological complications of IE represent the worst with guarded prognosis. The aim of this study is to describe the incidence, etiology, characteristics, risk factors, and outcome of children with neurological complications associated with IE. MATERIAL AND METHODS A retrospective cohort study was conducted from 2009 to 2019 where all pediatric patients who fulfilled the modified Duke criteria for IE were included. We divided the cases into 2 groups: IE with neurological complications and IE without neurological complications control group. We compared the two groups statistically and analyzed the results. RESULTS We identified 31 (17 male, 14 female) patients with IE. Neurological complications occurred in 7/31 (23%) patients, mainly in the form of a stroke. Gram-positive microbes were the main causative agents for IE (52%) followed by gram-negative (14%), then fungal organisms (3%). Univariate analysis identified the following risk factors for neurological complications: lower body weight, higher C- reactive protein (CRP) level, and left-sided valvular lesions with P values of (0.0003, 0.0001, and 0.04), respectively.Although mortality was higher in the neurological complications group, it was 43% in comparison to 21% in the control group and it did not reach statistical significance (P = .49). Large vegetation size (more than 10 mm) was seen in 57% of patients with neurological complications as compared to 16% in the control group (P = .052). CONCLUSION Neurological complications occurred in almost a quarter of children with IE. Possible risk factors include lower body weight, left-sided valvular lesion, and higher levels of inflammatory markers (CRP). Stroke was the most common neurological complication encountered with possible increased risk of mortality.
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Affiliation(s)
- Tala AlBassri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Maha Sheikho
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Farah Chaikhouni
- Division of Pediatric Cardiology, Department of Cardiac Sciences, King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Fahad Al Habshan
- Division of Pediatric Cardiology, Department of Cardiac Sciences, King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mohamed S. Kabbani
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Division of Pediatric Cardiac Intensive Care, Department of Cardiac Sciences, King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- Corresponding author. Pediatric Cardiac ICU, MC 1423, King Abdulaziz Medical City, P.O. BOX 22490, Riyadh, 11426, Saudi Arabia.
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Vieira E, Faquini IV, Silva JL, Griz MFL, Cezar AB, Almeida NS, Azevedo-Filho HRC. Subarachnoid neurocysticercosis and an intracranial infectious aneurysm: case report. Neurosurg Focus 2019; 47:E16. [DOI: 10.3171/2019.5.focus19280] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 05/21/2019] [Indexed: 11/06/2022]
Abstract
Infectious intracranial aneurysms (IIAs) represent 2%–6% of all intracranial aneurysms and, classically, have been associated with bacterial or fungal agents. The authors report the case of a 42-year-old woman who presented with a typical history of subarachnoid hemorrhage. Digital subtraction angiography (DSA) showed an aneurysmal dilatation on the frontal M2 segment of the left middle cerebral artery (MCA). The patient was treated surgically, and multiple cysts were found in the left carotid and sylvian cisterns, associated with a dense inflammatory exudate that involved the MCA. The cysts were removed, and a fusiform aneurysmal dilatation was identified. The lesion was not amenable to direct clipping, so the authors wrapped it. Histopathological analysis of the removed cysts revealed the typical pattern of subarachnoid neurocysticercosis. The patient received cysticidal therapy with albendazole and corticosteroids, and she recovered uneventfully. Follow-up DSA performed 6 months after surgery showed complete resolution of the aneurysm. The authors performed a review of the literature and believe that there is sufficient evidence to affirm that the subarachnoid form of neurocysticercosis may lead to the development of an IIA and that Taenia solium should be listed among the possible etiological agents of IIAs, along with bacterial and fungal agents.
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5
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Management of Stroke in Neonates and Children: A Scientific Statement From the American Heart Association/American Stroke Association. Stroke 2019; 50:e51-e96. [DOI: 10.1161/str.0000000000000183] [Citation(s) in RCA: 240] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Amir G, Frenkel G, Rotstein A, Nachum E, Bruckheimer E, Lowenthal A, Einbinder T, Birk E. Urgent Surgical Treatment of Aortic Endocarditis in Infants and Children. Pediatr Cardiol 2019; 40:580-584. [PMID: 30604277 DOI: 10.1007/s00246-018-2030-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 12/04/2018] [Indexed: 10/27/2022]
Abstract
Infective endocarditis (IE) in the pediatric population can present as a life-threatening condition. Optimal timing for surgical intervention should consider surgical risks versus the risk of neurologic complications. We herein report our experience with this group of critically ill children. Retrospective analysis of patient charts of all patients who underwent urgent surgical treatment of aortic IE from 1994 to 2014 was performed. Nine patients with acute storming IE of the aortic valve or the ascending aorta were urgently operated (eight normal heart, one congenital aortic stenosis), age ranged from 8 weeks to 4.2 years. Causative organisms were Staphylococcus aureus (2), Staphylococcus coagulase negative (1), Kingella kingae (2), Streptococcus pneumoniae (2), or culture negative (2). Presenting symptoms other than hemodynamic instability were neurologic decompensation (5) coronary embolization (1) and cardiogenic shock due to scalded skin syndrome (1). CT and MRI demonstrated significant brain infarcts in four patients. Operations performed were the Ross operation (7) and ascending aortic reconstruction (2). There were no operative deaths. At a median follow-up of 6 years (range 2-196 months), all patients are alive and well. Re-intervention included homograft replacement (2) and transcatheter Melody valve implantation (1). At their last follow-up, the neo-aortic valve was functional in all patients with minimal regurgitation and all had full resolution of the neurological deficits. Urgent surgical treatment for aortic valve IE in infants is challenging. Although surgery is complex and pre-disposing conditions such as sepsis, neurologic and cardiac decompensations are prevalent, operative results are excellent and gradual and significant neurologic improvement was noted over time.
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Affiliation(s)
- Gabriel Amir
- Department of Pediatric Cardiac Surgery, Schneider Children's Medical Center of Israel, 14 Kaplan st., Petach Tikva, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Georgy Frenkel
- Department of Pediatric Cardiac Surgery, Schneider Children's Medical Center of Israel, 14 Kaplan st., Petach Tikva, Israel
| | - Amichay Rotstein
- Department of Pediatric Cardiology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elchanan Nachum
- Department of Pediatric Intensive Care, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elchanan Bruckheimer
- Department of Pediatric Cardiology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Lowenthal
- Department of Pediatric Cardiology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tom Einbinder
- Department of Pediatric Cardiology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Einat Birk
- Department of Pediatric Cardiology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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7
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Cao GF, Bi Q. Pediatric Infective Endocarditis and Stroke: A 13-Year Single-Center Review. Pediatr Neurol 2019; 90:56-60. [PMID: 30420107 DOI: 10.1016/j.pediatrneurol.2018.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 07/04/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We explored the relationship between pediatric infective endocarditis and stroke. PATIENTS AND METHODS All children encountered with infective endocarditis from January 2002 to December 2015 were included as our sample, and their medical records were comprehensively reviewed. RESULTS Sixty children with infective endocarditis were identified, including 30 boys and 30 girls aged eight months to 18 years (mean ± SD: 10.3 ± 5.6), and om 43 (71.6%) of these individuals had congenital heart disease. Left-sided endocarditis occurred in 25 patients (41.7%), and vegetations were found in 58 individuals (96.6%). The most often encountered microorganisms were Streptococcus viridans and Staphylococcus aureus, which were identified in five and four patients, respectively. Postendocarditis stroke occurred in nine patients, including five with cerebral infarction, two with intracerebral hemorrhage, and one with subarachnoid hemorrhage. The remaining child experienced cerebral infarction, intracerebral hemorrhage and subarachnoid hemorrhage simultaneously. The incidence of stroke in children with left-sided endocarditis was significantly higher than that of which in those who had right-sided endocarditis (32% versus 2.8%, P < 0.01). The most common manifestation of stroke was hemiparesis (55.5%). Two girls died of stroke, and the mortality rate in the patients who had stroke was significantly higher than that in those without stroke (22.2 % versus 3.9 %, P < 0.05). CONCLUSIONS Our data indicate that stroke is common among children with infective endocarditis, especially in those with left-sided endocarditis, and major stroke may increase their risk of death. Congenital heart disease is the main underlying disease in children with infective endocarditis in China.
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Affiliation(s)
- Gui-Fang Cao
- Department of Neurology, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China.
| | - Qi Bi
- Department of Neurology, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China
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Thom K, Hanslik A, Russell JL, Williams S, Sivaprakasam P, Allen U, Male C, Brandão LR. Incidence of infective endocarditis and its thromboembolic complications in a pediatric population over 30years. Int J Cardiol 2017; 252:74-79. [PMID: 29126655 DOI: 10.1016/j.ijcard.2017.10.085] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 10/13/2017] [Accepted: 10/23/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pediatric infective endocarditis (IE) has been associated with high morbidity and mortality, mostly related to thromboembolic complications (TEC). The objective of our study was to describe the experience in children with IE and to review the changes over a thirty-year period, regarding origin of IE, incidence of vegetations, TEC and their respective morbidity and mortality rates. METHODS A retrospective chart review of children aged 0-18years with IE defined by the Duke Criteria and admitted to The Hospital for Sick Children, was conducted. Data were divided into three periods (P); P1 (1979-1988); P2 (1989-1998); and P3 (1999-2008). RESULTS The study included 113 patients, median age 7yrs.; females: 46 (41%), congenital heart defects 95 (84%), comparable in all periods. Overall, cardiac vegetations were found in 68/113 patients (60%); large vegetations (≥1cm) in 32 patients (28%). Fourty-five (45/133 [40%]) TEC were documented, 22 patients (20%) developed cerebrovascular events (CVE) and 23 patients (20%) had non-CVE. Patients diagnosed during P3 were older, had more vegetations (p<0.05), and a higher incidence of community acquired-IE (p<0.05). Overall, mortality was 15%, comparable in all periods. Significant risk factors for mortality were vegetations (HR 6.44; 95% CI: 2.07-20.01, p=0.002) and heart failure (HR 28.39; 95% CI: 10.49-76.85, p<0.001). CONCLUSIONS Over the study period, we report a growing incidence of community acquired pediatric IE in older children accompanied by an increasing rate of TEC. Heart failure and vegetations were associated with an increased mortality. These preliminary data need to be confirmed by prospective data.
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Affiliation(s)
- K Thom
- Pediatric Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Division of Pediatric Cardiology, Department of Children and Adolescent Medicine, Medical University Vienna, Austria
| | - A Hanslik
- Division of Pediatric Cardiology, Department of Children and Adolescent Medicine, Medical University Vienna, Austria
| | - J L Russell
- Pediatric Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Canada
| | - S Williams
- Pediatric Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - P Sivaprakasam
- Pediatric Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - U Allen
- Infectious Disease, The Hospital for Sick Children, Toronto, Canada
| | - C Male
- Division of Pediatric Cardiology, Department of Children and Adolescent Medicine, Medical University Vienna, Austria
| | - L R Brandão
- Pediatric Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada.
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9
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Ischaemic stroke in children with cardiopathy: An epidemiological study. NEUROLOGÍA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.nrleng.2016.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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10
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Vázquez-López M, Castro-de Castro P, Barredo-Valderrama E, Miranda-Herrero MC, Gil-Villanueva N, Alcaraz-Romero AJ, Jiménez-de Domingo A, Pascual-Pascual SI. Ischaemic stroke in children with cardiopathy: An epidemiological study. Neurologia 2016; 32:602-609. [PMID: 27296499 DOI: 10.1016/j.nrl.2016.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 03/13/2016] [Accepted: 03/29/2016] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Ischaemic stroke is rare during childhood. Congenital and acquired heart diseases are one of the most important risk factors for arterial ischaemic stroke (AIS) in children. PATIENTS AND METHODS We conducted a retrospective study of all children with AIS and heart disease diagnosed between 2000 and 2014. RESULTS We included 74 children with heart disease who were eligible for inclusion. 60% were boys with a mean stroke age of 11 months. 20% of the patients died during the study period. 90% of the patients had a congenital heart disease, while cyanotic heart disease was identified in 60%. Hypoplastic left heart syndrome was the most frequent heart disease. In 70% of patients AIS was directly associated with heart surgery, catheterisation or ventricular assist devices. Most patients with AIS were in the hospital. Seizures and motor deficit were the most frequent symptoms. Most patient diagnoses were confirmed by brain CT. The AIS consisted of multiple infarcts in 33% of the cases, affected both hemispheres in 27%, and involved the anterior and posterior cerebral circulation in 10%. CONCLUSIONS Arterial ischaemic strokes were mainly associated with complex congenital heart diseases, and heart procedures and surgery (catheterisation). AIS presented when patients were in-hospital and most of the patients were diagnosed in the first 24hours.
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Affiliation(s)
- M Vázquez-López
- Sección de Neuropediatría, Hospital Materno Infantil Gregorio Marañón, Madrid, España.
| | - P Castro-de Castro
- Sección de Neuropediatría, Hospital Materno Infantil Gregorio Marañón, Madrid, España
| | - E Barredo-Valderrama
- Sección de Neuropediatría, Hospital Materno Infantil Gregorio Marañón, Madrid, España
| | - M C Miranda-Herrero
- Sección de Neuropediatría, Hospital Materno Infantil Gregorio Marañón, Madrid, España
| | - N Gil-Villanueva
- Sección de Cardiología Infantil, Hospital Materno Infantil Gregorio Marañón, Madrid, España
| | - A J Alcaraz-Romero
- Sección de Unidad de Cuidados Intensivos Pediátricos, Hospital Materno Infantil Gregorio Marañón, Madrid, España
| | - A Jiménez-de Domingo
- Sección de Neuropediatría, Hospital Materno Infantil Gregorio Marañón, Madrid, España
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Baltimore RS, Gewitz M, Baddour LM, Beerman LB, Jackson MA, Lockhart PB, Pahl E, Schutze GE, Shulman ST, Willoughby R. Infective Endocarditis in Childhood: 2015 Update. Circulation 2015; 132:1487-515. [DOI: 10.1161/cir.0000000000000298] [Citation(s) in RCA: 201] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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12
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Bin Abdulhak AA, Baddour LM, Erwin PJ, Hoen B, Chu VH, Mensah GA, Tleyjeh IM. Global and regional burden of infective endocarditis, 1990-2010: a systematic review of the literature. Glob Heart 2015; 9:131-43. [PMID: 25432123 DOI: 10.1016/j.gheart.2014.01.002] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Infective endocarditis (IE) is a life-threatening disease associated with serious complications. The GBD 2010 (Global Burden of Disease, Injuries, and Risk Factors) study IE expert group conducted a systematic review of IE epidemiology literature to inform estimates of the burden on IE in 21 world regions in 1990 and 2010. The disease model of IE for the GBD 2010 study included IE death and 2 sequelae: stroke and valve surgery. Several medical and science databases were searched for IE epidemiology studies in GBD high-, low-, and middle-income regions published between 1980 and 2008. The epidemiologic parameters of interest were IE incidence, proportions of IE patients who developed stroke or underwent valve surgery, and case fatality. Literature searches yielded 1,975 unique papers, of which 115 published in 10 languages were included in the systematic review. Eligible studies were population-based (17%), multicenter hospital-based (11%), and single-center hospital-based studies (71%). Population-based studies were reported from only 6 world regions. Data were missing or sparse in many low- and middle-income regions. The crude incidence of IE ranged between 1.5 and 11.6 cases per 100,000 people and was reported from 10 countries. The overall mean proportion of IE patients that developed stroke was 0.158 ± 0.091, and the mean proportion of patients that underwent valve surgery was 0.324 ± 0.188. The mean case fatality risk was 0.211 ± 0.104. A systematic review for the GBD 2010 study provided IE epidemiology estimates for many world regions, but highlighted the lack of information about IE in low- and middle-income regions. More complete knowledge of the global burden of IE will require improved IE surveillance in all world regions.
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Affiliation(s)
- Aref A Bin Abdulhak
- Department of Medicine, School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Larry M Baddour
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | | | - Bruno Hoen
- Department of Infectious Diseases, Dermatology, and Internal Medicine, University Medical Center of Guadeloupe, Cedex, France
| | - Vivian H Chu
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - George A Mensah
- Center for Translation Research and Implementation Science (CTRIS), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Imad M Tleyjeh
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA; Division of Epidemiology, Mayo Clinic, Rochester, MN, USA; Department of Medicine, Infectious Diseases Section, King Fahad Medical City, Riyadh, Saudi Arabia; College of Medicine, Al Faisal University, Riyadh, Saudi Arabia.
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Petrukhin AS, Bobylova MY, Michailova SV. [Etiology of stroke in children]. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:64-74. [PMID: 26121000 DOI: 10.17116/jnevro20151153264-74] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The lecture contains information on terminology, etiology and pathogenesis of stroke in children. The current statistics on the incidence of stroke in the pediatric population, prognosis and principles of early diagnosis are presented. Different states, complicating stroke in children are described.
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Affiliation(s)
- A S Petrukhin
- Pirogov Russian National Research Medical University, Moscow
| | - M Yu Bobylova
- St. Luka Children Neurology and Epilepsy Institute, Moscow
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14
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Sinclair AJ, Fox CK, Ichord RN, Almond CS, Bernard TJ, Beslow LA, Chan AKC, Cheung M, deVeber G, Dowling MM, Friedman N, Giglia TM, Guilliams KP, Humpl T, Licht DJ, Mackay MT, Jordan LC. Stroke in children with cardiac disease: report from the International Pediatric Stroke Study Group Symposium. Pediatr Neurol 2015; 52:5-15. [PMID: 25532775 PMCID: PMC4936915 DOI: 10.1016/j.pediatrneurol.2014.09.016] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 09/17/2014] [Accepted: 09/22/2014] [Indexed: 01/19/2023]
Abstract
BACKGROUND Cardiac disease is a leading cause of stroke in children, yet limited data support the current stroke prevention and treatment recommendations. A multidisciplinary panel of clinicians was convened in February 2014 by the International Pediatric Stroke Study group to identify knowledge gaps and prioritize clinical research efforts for children with cardiac disease and stroke. RESULTS Significant knowledge gaps exist, including a lack of data on stroke incidence, predictors, primary and secondary stroke prevention, hyperacute treatment, and outcome in children with cardiac disease. Commonly used diagnostic techniques including brain computed tomography and ultrasound have low rates of stroke detection, and diagnosis is frequently delayed. The challenges of research studies in this population include epidemiologic barriers to research such as small patient numbers, heterogeneity of cardiac disease, and coexistence of multiple risk factors. Based on stroke burden and study feasibility, studies involving mechanical circulatory support, single ventricle patients, early stroke detection strategies, and understanding secondary stroke risk factors and prevention are the highest research priorities over the next 5-10 years. The development of large-scale multicenter and multispecialty collaborative research is a critical next step. The designation of centers of expertise will assist in clinical care and research. CONCLUSIONS There is an urgent need for additional research to improve the quality of evidence in guideline recommendations for cardiogenic stroke in children. Although significant barriers to clinical research exist, multicenter and multispecialty collaboration is an important step toward advancing clinical care and research for children with cardiac disease and stroke.
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Affiliation(s)
- Adriane J Sinclair
- Division of Neurology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Christine K Fox
- Department of Neurology, University of California, San Francisco, San Francisco, California
| | - Rebecca N Ichord
- Departments of Neurology and Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christopher S Almond
- Department of Pediatrics, Stanford University, Lucile Packard Children's Hospital, Palo Alto, California
| | - Timothy J Bernard
- Pediatrics, Neurology and Child Neurology, University of Colorado, Aurora, Colorado
| | - Lauren A Beslow
- Department of Pediatric Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - Anthony K C Chan
- Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Michael Cheung
- Royal Children's Hospital, Murdoch Children's Research Institute, University of Melbourne, Parkville, Victoria, Australia
| | - Gabrielle deVeber
- Division of Neurology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Michael M Dowling
- Department of Pediatrics and Neurology, UT Southwestern Medical Center, Dallas, Texas
| | - Neil Friedman
- Center for Pediatric Neurology, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Therese M Giglia
- Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kristin P Guilliams
- Division of Pediatric Neurology, Department of Neurology, Washington University in St. Louis, St. Louis, Missouri; Division of Critical Care, Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri
| | - Tilman Humpl
- Division of Cardiac Critical Care, Department of Critical Care Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Daniel J Licht
- Departments of Neurology and Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mark T Mackay
- Department of Neurology, Royal Children's Hospital, Melbourne, Victoria, Australia; Murdoch Children's Research Institute Melbourne, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia
| | - Lori C Jordan
- Division of Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.
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Williams JTB, Fagan HA. A 15-year-old boy with congenital heart disease, fevers, and acute onset of dysarthria: infective endocarditis. Pediatr Ann 2014; 43:64-7. [PMID: 24512155 DOI: 10.3928/00904481-20140127-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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16
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de Los Reyes E, Roach ES. Neurologic complications of congenital heart disease and its treatment. HANDBOOK OF CLINICAL NEUROLOGY 2014; 119:49-59. [PMID: 24365288 DOI: 10.1016/b978-0-7020-4086-3.00005-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Advances in surgical and medical management have dramatically improved the survival of individuals with congenital cardiac anomalies. Various neurologic complications occur in association with congenital heart disease, including cognitive impairment and ischemic stroke. The likelihood of stroke is greatest in individuals with severe structural cardiac defects such as tetralogy of Fallot, transposition of the great arteries, or hypoplastic left heart syndrome. A persistent foramen ovale adds little or no additional stroke risk unless it is associated with an atrial septal aneurysm or other anomaly. Individuals with congenital heart disease caused by genetic abnormalities are apt to have other anomalies as well. Complications related to correction of cardiac anomalies include seizures, ischemia, stroke, and movement disorders.
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Affiliation(s)
| | - E Steve Roach
- Division of Child Neurology, Ohio State University, Columbus, OH, USA
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17
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Ghosh PS, Friedman NR, Ghosh D. Fever, lethargy, and leg weakness in a 9-month-old boy. Clin Pediatr (Phila) 2012; 51:808-11. [PMID: 22511192 DOI: 10.1177/0009922812441677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Partha S Ghosh
- Pediatric Neurology, Cleveland Clinic, Cleveland, OH 44195, USA.
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18
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Accident vasculaire cérébral hémorragique révélant une endocardite infectieuse. ANNALES FRANCAISES DE MEDECINE D URGENCE 2012. [DOI: 10.1007/s13341-012-0188-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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19
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Millichap JG. Stroke Hospitalizations and Risk Factors. Pediatr Neurol Briefs 2012. [DOI: 10.15844/pedneurbriefs-26-1-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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20
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Nouyrigat V, Patteau G, Bajolle F, Anthoine-Milhommes MC, Chappuy H, Chéron G. [Neurological complications revealing infectious endocarditis: 2 case reports]. Arch Pediatr 2011; 18:401-4. [PMID: 21397467 DOI: 10.1016/j.arcped.2011.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Revised: 04/06/2010] [Accepted: 01/08/2011] [Indexed: 11/24/2022]
Abstract
Neurological signs are reported in less than 20% of infectious endocarditis (IE) cases. The most frequent complications include cerebral infarction, intracerebral hemorrhage, meningitis, and mycotic aneurysm. We describe two patients, one with congenital heart disease and the other with normal heart, who presented neurological manifestations and fever leading to an IE diagnosis. Neurological complications may be the first symptom of infectious endocarditis and are a major factor associated with increased morbidity and mortality. Early diagnosis and early treatment will minimize cardiac and neurological morbidities.
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Affiliation(s)
- V Nouyrigat
- Service des urgences pédiatriques, hôpital Necker-Enfants-Malades, AP-HP, faculté de médecine, université Paris Descartes, 149, rue de Sèvres, 75015 Paris, France.
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Abstract
We reviewed all papers most recently reported in the literature related to infected arterial aneurysms (IAAs) affecting the aorta and vascular beds other than the aorta. In this article, we report on vascular beds other than the aorta. As is the case for aortic IAAs, infected non-aortic aneurysms are rarely encountered. The majority of recent studies are limited to case reports and small series of unusual infected aneurysms. A comprehensive review of this entity was performed based on the available literature from January through December 2008 in all languages. Available reports were analyzed with respect to demographic features, type of presentation, methods of diagnosis and therapy, follow-up, and outcome (morbidity and mortality).
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Affiliation(s)
- Luis R León
- Tucson Medical Center and Carondelet Health Network-Department of Vascular Surgery, University of Arizona Health Science Center, Agave Surgical Associates, 5240 East Knight Drive, Suite 118, Tucson, AZ 85712, USA.
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22
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Tan M, Armstrong D, Birken C, Bitnun A, Caldarone CA, Cox P, Kahr W, Macgregor D, Askalan R. Bacterial endocarditis in a child presenting with acute arterial ischemic stroke: should thrombolytic therapy be absolutely contraindicated? Dev Med Child Neurol 2009; 51:151-4. [PMID: 19191846 DOI: 10.1111/j.1469-8749.2008.03188.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Thrombolysis is considered to be contraindicated in acute ischemic stroke secondary to infective endocarditis (IE). We report a 12-year-old female who presented with acute dense right hemiparesis and aphasia. Cranial magnetic resonance imaging and angiography showed multiple diffusion-restricted lesions in the left hemisphere and absence of flow in the left internal carotid artery. She was treated with intra-arterial tissue plasminogen activator within 6 hours of her presentation. Subsequently she was diagnosed with pneumococcal endocarditis and underwent debridement of vegetations and patch repair of the mitral valve. The patient did not have hemorrhagic complications following thrombolytic therapy or surgery. Pathological analysis of the mitral valve vegetations revealed mostly fibrin thrombus. Follow-up imaging showed complete recanalization of the left internal carotid artery, and the patient had a remarkable neurological recovery. This is the first case report of successful intra-arterial thrombolytic therapy in childhood IE-related stroke. We believe that thrombolytic therapy contributed to a favorable outcome in our patient and may be safe in selected patients with childhood IE-related acute ischemic stroke.
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Affiliation(s)
- Marilyn Tan
- Department of Pediatrics, Hospital for Sick Children, Toronto, Canada
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