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Awlad Thani S, Al Jamei SM, Al Azri KN, Al Alawi K, Al Shabibi S. Native Aortic Valve Infective Endocarditis Secondary to Community-Acquired Methicillin-Resistant Staphylococcus aureus: A Case Report and Literature Review. Cureus 2024; 16:e55341. [PMID: 38559539 PMCID: PMC10981920 DOI: 10.7759/cureus.55341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2024] [Indexed: 04/04/2024] Open
Abstract
Infective endocarditis (IE) refers to a microbial infection affecting either a heart valve or endocardium, resulting in tissue damage and the formation of vegetation. Native aortic valve endocarditis in children is rare and is associated with serious complications related to valvular insufficiency and systemic embolizations. As reports about community-acquired methicillin-resistant Staphylococcus aureus (MRSA) native aortic valve endocarditis in children are very scarce, we report this case along with a literature review about its complications and management. Here, we report the case of a seven-month-old infant who was previously healthy and presented with signs and symptoms of shock and systemic embolizations secondary to native aortic valve IE. His blood culture showed MRSA. He developed aortic valve insufficiency heart failure and multiorgan septic emboli that progressed to fatal refractory multiorgan failure. The management of complicated aortic valve endocarditis in children is challenging and needs a multidisciplinary team approach and prompt intervention.
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2
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Abdel-Haq N, Shawaqfeh A, Gupta S, Ang JY, Thomas R, Asmar BI. Infective Endocarditis at a Referral Children's Hospital During 19-Year Period: Trends and Outcomes. Pediatr Cardiol 2023:10.1007/s00246-023-03274-y. [PMID: 37610636 DOI: 10.1007/s00246-023-03274-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/10/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND We noted a recent increase in cases of infective endocarditis (IE) at our institution. The purpose of the study is to examine the incidence, risk factors, microbiology and outcome of IE in our pediatric population. METHODS Retrospective review of IE cases during 2002-2020 at Children's Hospital of Michigan, Detroit. RESULTS 68 patients with IE were identified. There was a 2-fold increase in incidence during the 2012-2020 (late period) compared to the 2002-2011 (early period). The most common predisposing conditions were congenital heart disease (CHD) in 39 (57.4%) and central venous catheter (CVC) in 19 (27.9%). CHD was more frequent in the late period (29/43, 67.4%) compared to early period (10/25, 40.0%) (p = 0.042). In CHD patients, palliative or corrective cardiac surgery was performed prior to IE diagnosis in 4/25 (16%) in early period and 23/43 (53.5%) in the late period (p = 0.004). S. aureus was the most common causative organism (35.3%) followed by streptococci (22.1%). Valve replacement or valvuloplasty was performed in 22.1% of patients. Complications occurred in 20 (29.4%). Mortality occurred in 7 (10.3%): 3 had CHD, 3 had CVC and underlying conditions and 1 had fulminant MRSA infection. CONCLUSION(S) The higher incidence of IE during the late period is likely due to an increase in patients with CHD who had undergone prior cardiac surgery. S. aureus was the predominant pathogen in all patients including those with CHD, followed by streptococci. IE in children continues to be associated with high rates of morbidity and mortality.
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Affiliation(s)
- Nahed Abdel-Haq
- Children's Hospital of Michigan, Detroit, MI, USA.
- Central Michigan University, Mount Pleasant, MI, USA.
- Wayne State University, Detroit, MI, USA.
- Division of Infectious Diseases, Children's Hospital of Michigan, 3901 Beaubien Blvd Detroit, Mount Pleasant, MI, 48201, USA.
| | | | | | - Jocelyn Y Ang
- Children's Hospital of Michigan, Detroit, MI, USA
- Central Michigan University, Mount Pleasant, MI, USA
- Wayne State University, Detroit, MI, USA
| | - Ronald Thomas
- Children's Hospital of Michigan, Detroit, MI, USA
- Central Michigan University, Mount Pleasant, MI, USA
| | - Basim I Asmar
- Children's Hospital of Michigan, Detroit, MI, USA
- Central Michigan University, Mount Pleasant, MI, USA
- Wayne State University, Detroit, MI, USA
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3
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Sahai A, Suarez WA. Reversible Cortical Blindness in Pediatric Native Valve Endocarditis. Pediatr Emerg Care 2021; 37:e1750-e1752. [PMID: 31929392 DOI: 10.1097/pec.0000000000002006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Native valve endocarditis, a rare phenomenon in children, can present with septic embolization and devastating consequences. We present a healthy child with bilateral cortical blindness due to native mitral valve endocarditis. After prompt medical and surgical therapy, he regained complete vision. Early surgical intervention resulted in the best outcome.
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Affiliation(s)
- Archit Sahai
- From the Department of Pediatrics, University of Toledo College of Medicine and Life Sciences, Toledo OH
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4
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Avasiloaiei AL, Iftime E, Scripcaru DC, Petrariu A, Zonda GI, Stamatin M, Păduraru L. Fatal neonatal persistent pulmonary hypertension caused by vegetations of infective endocarditis - case report and review of the literature. Arch Clin Cases 2021; 7:40-45. [PMID: 34754926 PMCID: PMC8565684 DOI: 10.22551/2020.27.0702.10171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Neonatal infective endocarditis is a rare condition and usually pertains to a specific class of immunologically depressed preterm infants, with a long history of invasive procedures in the Neonatal Intensive Care Unit. We report the case of an aggressive and fatal neonatal infective endocarditis in a full-term infant, who developed massive endocardial vegetations on the tricuspid valve, leading to persistent pulmonary hypertension of the newborn, unresponsive to nitric oxide ventilation. Post-mortem cardiac cultures were positive with Serratia marcescens, an unusual germ for an early-onset infection, which was absent in blood cultures.
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Affiliation(s)
- Andreea Luciana Avasiloaiei
- Department of Mother and Child Health, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania.,Neonatal Intensive Care Unit, Cuza-Voda Clinical Hospital of Obstetrics and Gynecology, Iasi
| | - Ecaterina Iftime
- Neonatal Intensive Care Unit, Cuza-Voda Clinical Hospital of Obstetrics and Gynecology, Iasi
| | | | - Andrei Petrariu
- Neonatal Intensive Care Unit, Cuza-Voda Clinical Hospital of Obstetrics and Gynecology, Iasi
| | - Gabriela Ildiko Zonda
- Department of Mother and Child Health, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania.,Neonatal Intensive Care Unit, Cuza-Voda Clinical Hospital of Obstetrics and Gynecology, Iasi
| | - Maria Stamatin
- Neonatal Intensive Care Unit, Cuza-Voda Clinical Hospital of Obstetrics and Gynecology, Iasi
| | - Luminița Păduraru
- Department of Mother and Child Health, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania.,Neonatal Intensive Care Unit, Cuza-Voda Clinical Hospital of Obstetrics and Gynecology, Iasi
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5
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Lowenthal A, Weisblum-Neuman H, Birk E, Ashkenazi-Hoffnung L, Levy I, Ben-Zvi H, Amir G, Frenkel G, Bruckheimer E, Yarden-Bilavsky H, Marom D, Shostak E, Nahum E, Dagan T, Chodick G, Scheuerman O. Clinical Features and Comparison of Kingella and Non-Kingella Endocarditis in Children, Israel. Emerg Infect Dis 2021; 27:703-709. [PMID: 33622463 PMCID: PMC7920667 DOI: 10.3201/eid2703.203022] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Kingella spp. have emerged as an important cause of invasive pediatric diseases. Data on Kingella infective endocarditis (KIE) in children are scarce. We compared the clinical features of pediatric KIE cases with those of Streptococcus species IE (StIE) and Staphylococcus aureus IE (SaIE). A total of 60 patients were included in the study. Throughout the study period, a rise in incidence of KIE was noted. KIE patients were significantly younger than those with StIE and SaIE, were predominately boys, and had higher temperature at admission, history of oral aphthae before IE diagnosis, and higher lymphocyte count (p<0.05). Pediatric KIE exhibits unique features compared with StIE and SaIE. Therefore, in young healthy children <36 months of age, especially boys, with or without a congenital heart defect, with a recent history of oral aphthae, and experiencing signs and symptoms compatible with endocarditis, Kingella should be suspected as the causative pathogen.
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6
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Song SH, Bang JS, Han MS, Yun KW, Lee SY, Song MK, Kim GB, Bae EJ, Kim WH, Choi EH. Changes in the Etiology and Clinical Characteristics of Pediatric Infective Endocarditis in South Korea. Pediatr Infect Dis J 2021; 40:123-127. [PMID: 33021589 DOI: 10.1097/inf.0000000000002917] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Changes in the epidemiology, clinical manifestations, and outcomes of infective endocarditis (IE) have been reported in recent years. This study was performed to analyze changing trends in the etiology of IE in children in South Korea. STUDY DESIGN A retrospective study of children with IE was conducted from 2 hospitals in Korea from 2004 to 2019. IE was defined according to the Modified Duke criteria. We analyzed the etiology and clinical outcome of 96 cases and compared the etiology with that during 1987-1997, as described in a previous study. RESULTS A total of 96 cases in 89 children satisfied the modified Duke criteria. The median age was 9.5 years. Preexisting structural heart diseases were identified in 81 cases (84.4%). Ten of the 15 cases with normal heart anatomy had a history of indwelling central venous catheters and underlying noncardiac conditions. Of the 72 identified organisms, common pathogens included Staphylococcus aureus, 24 (32.9%); viridans streptococci, 22 (30.2%); coagulase-negative staphylococci, 14 (19.2%); and Candida species, 7 (9.6). Sixty-three cases (66.7%) required surgical intervention, and the overall fatality rate was 7.9%. Compared with the period of 1987-1997, an increasing trend in the proportion of staphylococci as the etiology of IE in 2004-2019 was observed (26.7% vs. 51.8%, P = 0.029). In addition, S. aureus was associated with the high rate of developing complications (P < 0.05). CONCLUSION In South Korea, Gram-positive cocci represent 85% of all etiologic agents of IE in children with an increasing trend in the proportion of staphylococci.
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Affiliation(s)
- Seung Ha Song
- From the Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Ji Seok Bang
- Department of Pediatrics, Sejong General Hospital, Bucheon, South Korea
| | - Mi Seon Han
- Department of Pediatrics, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Ki Wook Yun
- From the Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Sang Yun Lee
- From the Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Mi Kyoung Song
- From the Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
| | - Gi Beom Kim
- From the Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Eun Jung Bae
- From the Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Woong Han Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Eun Hwa Choi
- From the Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
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7
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Song SH, Ahn B, Choi EH, Lee SP, Cho EY, Bae EJ, Lee SY, Song MK, Kim WH, Kim G, Kim TS, Han MS. Abiotrophia defectiva as a cause of infective endocarditis with embolic complications in children. Infection 2020; 48:783-790. [PMID: 32474827 DOI: 10.1007/s15010-020-01454-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 05/24/2020] [Indexed: 02/08/2023]
Abstract
Abiotrophia defectiva is a rare pathogen of infective endocarditis (IE) but is frequently involved in embolic complication and valvular dysfunction. IE caused by A. defectiva in children is poorly studied. This study reports four cases of A. defectiva IE in children and reviews previously reported five pediatric cases of A. defectiva IE. Most of the patients presented with a subacute course, with prolonged fever or atypical symptoms. Eight patients had embolic complications at presentation. All nine children were treated with combination antimicrobial therapy and six of them received surgical intervention. All patients recovered well without relapse. A. defectiva should be considered in children with infective endocarditis, especially in those with atypical presentations. As complications are frequent and more than half of the patients need surgical treatment, prompt diagnosis along with appropriate treatment is necessary.
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Affiliation(s)
- Seung Ha Song
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Bin Ahn
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Eun Hwa Choi
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Pyo Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Eun Young Cho
- Department of Pediatrics, Chungnam National University Hospital, Daejeon, Korea
| | - Eun Jung Bae
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Yun Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Mi Kyoung Song
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Woong Han Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul, Korea
| | - Geena Kim
- Department of Pediatrics, Chungnam National University Hospital, Daejeon, Korea
| | - Taek Soo Kim
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Korea
| | - Mi Seon Han
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea. .,Department of Pediatrics, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Korea.
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8
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Ravindranath Waikar A, Uzamere O, Bailey K, Pierre L, Adeyinka A. A Unique Pathogen Causing Infective Endocarditis in a Three-year-old Girl. Cureus 2019; 11:e4249. [PMID: 31131172 PMCID: PMC6516622 DOI: 10.7759/cureus.4249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The overall incidence of infective endocarditis (IE) in adults has been reported to be 1.5 to 6.0 per 100,000 patient-years. In children, the incidence of IE in the general population is approximately three times lower. The presence of cyanotic congenital heart disease is considered to be the most strongly associated risk factor to develop IE. In approximately 8% to 10% of pediatric cases, IE develops without structural heart disease or any other readily identifiable risk factors. In these situations, the infection usually involves the aortic or mitral valve secondary to Staphylococcus aureus bacteremia. Streptococcus pneumoniae endocarditis in a female with no known risk factors is extremely rare and has no established optimal therapy. We hereby present a case of a three-year-old girl, with no identifiable risk factors diagnosed with IE caused by S. pneumoniae.
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9
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Abstract
BACKGROUND Perioperative infections have significant consequences for children with congenital heart disease (CHD), which can manifest as acute or chronic infection followed by poor growth and progressive cardiac failure. The consequences include delayed or higher-risk surgery, and increased postoperative morbidity and mortality. METHODS A systematic search for studies evaluating the burden and interventions to reduce perioperative infections in children with CHD was undertaken using PubMed. RESULTS Limited studies conducted in low- to middle-income countries demonstrated the large burden of perioperative infections among children with CHD. Most studies focussed on infections after surgery. Few studies evaluated strategies to prevent preoperative infection or the impact of infection on decision-making around the timing of surgery. Children with CHD have multiple risk factors for infections including delayed presentation, inadequate treatment of cardiac failure, and poor nutrition. CONCLUSIONS The burden of perioperative infections is high among children with CHD, and studies evaluating the effectiveness of interventions to reduce these infections are lacking. As good nutrition, early corrective surgery, and measures to reduce nosocomial infection are likely to play a role, practical steps can be taken to make surgery safer.
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10
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Risk factors for infective endocarditis in children with congenital heart diseases - A nationwide population-based case control study. Int J Cardiol 2017; 248:126-130. [DOI: 10.1016/j.ijcard.2017.08.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/18/2017] [Accepted: 08/04/2017] [Indexed: 12/29/2022]
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11
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Esposito S, Mayer A, Krzysztofiak A, Garazzino S, Lipreri R, Galli L, Osimani P, Fossali E, Di Gangi M, Lancella L, Denina M, Pattarino G, Montagnani C, Salvini F, Villani A, Principi N, Italian Pediatric Infective Endocarditis Registry. Infective Endocarditis in Children in Italy from 2000 to 2015. Expert Rev Anti Infect Ther 2016; 14:353-8. [PMID: 26708337 DOI: 10.1586/14787210.2016.1136787] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The Italian Society for Pediatric Infectious Diseases created a registry on children with infective endocarditis (IE) hospitalized in Italy. METHODS A cross-sectional survey was conducted on patients hospitalized due to IE in Italian paediatric wards between January 1, 2000, and June 30, 2015. RESULTS Over the 15-year study period, 47 IE episodes were observed (19 males; age range, 2-17 years). Viridans Streptococci were the most common pathogens among patients with predisposing cardiac conditions and Staphylococcus aureus among those without (37.9% vs. 5.5%, p = 0.018, and 6.9% vs. 27.8%, p = 0.089, respectively). Six of the 7 (85.7%) S. aureus strains were methicillin-resistant. The majority of patients with and without predisposing cardiac conditions recovered without any complications. CONCLUSION In Italy, paediatric IE develops without any previous predisposing factors in a number of children, methicillin-resistant S. aureus has emerged as a common causative agent and the therapeutic approach is extremely variable.
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Affiliation(s)
- Susanna Esposito
- a Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation , Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - Alessandra Mayer
- a Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation , Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - Andrzej Krzysztofiak
- b Unit of General Pediatrics and Pediatric Infectious Diseases , IRCCS Bambino Gesù Hospital , Rome , Italy
| | - Silvia Garazzino
- c Pediatric Infectious Diseases Unit, Regina Margherita Children's Hospital , University of Turin , Turin , Italy
| | - Rita Lipreri
- d Pediatric Unit , Niguarda Hospital , Milan , Italy
| | - Luisa Galli
- e Paediatric Infectious Disease Unit, Department of Health Sciences , University of Florence, Anna Meyer Children's University Hospital , Florence , Italy
| | - Patrizia Osimani
- f Pediatric Infectious Diseases Unit , Salesi Hospital , Ancona , Italy
| | - Emilio Fossali
- g Emergency Room Unit , Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - Maria Di Gangi
- h Pediatric Infectious Diseases Unit , Di Cristina Hospital , Palermo , Italy
| | - Laura Lancella
- b Unit of General Pediatrics and Pediatric Infectious Diseases , IRCCS Bambino Gesù Hospital , Rome , Italy
| | - Marco Denina
- c Pediatric Infectious Diseases Unit, Regina Margherita Children's Hospital , University of Turin , Turin , Italy
| | | | - Carlotta Montagnani
- e Paediatric Infectious Disease Unit, Department of Health Sciences , University of Florence, Anna Meyer Children's University Hospital , Florence , Italy
| | - Filippo Salvini
- i Pediatric Clinic, San Paolo Hospital , University of Milan , Milan , Italy
| | - Alberto Villani
- b Unit of General Pediatrics and Pediatric Infectious Diseases , IRCCS Bambino Gesù Hospital , Rome , Italy
| | - Nicola Principi
- a Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation , Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
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12
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Recombinant tissue plasminogen activator as a novel treatment option for infective endocarditis: a retrospective clinical study in 32 children. Cardiol Young 2016; 26:110-5. [PMID: 25682953 DOI: 10.1017/s104795111400273x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Infective endocarditis is a life-threatening infectious syndrome, with high morbidity and mortality. Current treatments for infective endocarditis include intravenous antibiotics, surgery, and involve a lengthy hospital stay. We hypothesised that adjunctive recombinant tissue plasminogen activator treatment for infective endocarditis may facilitate faster resolution of vegetations and clearance of positive blood cultures, and therefore decrease morbidity and mortality. This retrospective study included follow-up of patients, from 1997 through 2014, including clinical presentation, causative organism, length of treatment, morbidity, and mortality. We identified 32 patients, all of whom were diagnosed with endocarditis and were treated by recombinant tissue plasminogen activator. Among all, 27 patients (93%) had positive blood cultures, with the most frequent organisms being Staphylococcus epidermis (nine patients), Staphylococcus aureus (six patients), and Candida (nine patients). Upon treatment, in 31 patients (97%), resolution of vegetations and clearance of blood cultures occurred within hours to few days. Out of 32 patients, one patient (3%) died and three patients (9%) suffered embolic or haemorrhagic events, possibly related to the recombinant tissue plasminogen activator. None of the patients required surgical intervention to assist vegetation resolution. In conclusion, it appears that recombinant tissue plasminogen activator may become an adjunctive treatment for infective endocarditis and may decrease morbidity as compared with current guidelines. Prospective multi-centre studies are required to validate our findings.
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13
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Mishra RC, Barik R, Arif MA, Malempati AR. Right atrial fungal endocarditis with bilateral extensive pulmonary infiltration caused by Neoscytalidium dimidiatum in an immunocompetent child: first case report from India. Indian J Thorac Cardiovasc Surg 2015. [DOI: 10.1007/s12055-015-0405-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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14
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Abstract
Kingella kingae is a common etiology of pediatric bacteremia and the leading agent of osteomyelitis and septic arthritis in children aged 6 to 36 months. This Gram-negative bacterium is carried asymptomatically in the oropharynx and disseminates by close interpersonal contact. The colonized epithelium is the source of bloodstream invasion and dissemination to distant sites, and certain clones show significant association with bacteremia, osteoarthritis, or endocarditis. Kingella kingae produces an RTX (repeat-in-toxin) toxin with broad-spectrum cytotoxicity that probably facilitates mucosal colonization and persistence of the organism in the bloodstream and deep body tissues. With the exception of patients with endocardial involvement, children with K. kingae diseases often show only mild symptoms and signs, necessitating clinical acumen. The isolation of K. kingae on routine solid media is suboptimal, and detection of the bacterium is significantly improved by inoculating exudates into blood culture bottles and the use of PCR-based assays. The organism is generally susceptible to antibiotics that are administered to young patients with joint and bone infections. β-Lactamase production is clonal, and the local prevalence of β-lactamase-producing strains is variable. If adequately and promptly treated, invasive K. kingae infections with no endocardial involvement usually run a benign clinical course.
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Affiliation(s)
- Pablo Yagupsky
- Clinical Microbiology Laboratory, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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15
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Ware AL, Tani LY, Weng HY, Wilkes J, Menon SC. Resource utilization and outcomes of infective endocarditis in children. J Pediatr 2014; 165:807-12.e1. [PMID: 25064162 DOI: 10.1016/j.jpeds.2014.06.026] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 05/10/2014] [Accepted: 06/09/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate resource use and outcomes of infective endocarditis in children with and without preexisting heart disease via a national cohort. STUDY DESIGN Children <19 years of age hospitalized from 2004 to 2010 with infective endocarditis at 37 centers in the Pediatric Health Information Systems database were included. We excluded children primarily hospitalized for chronic medical conditions. We used regression analysis to evaluate factors associated with poor outcomes (defined as mortality, mechanical cardiac support, or stroke). RESULTS There were 1033 cases of infective endocarditis, of which 663 had heart disease and 370 did not. Compared with the group without heart disease, infective endocarditis in the cohort with heart disease occurred at younger age, was more commonly attributable to streptococcus, was more likely to require cardiac surgery for infective endocarditis, and was associated with a lower risk of stroke. Mortality was 6.7% (n = 45) and 3.5% (n = 13) in groups with and without heart disease, respectively. Factors associated with poor outcome in the cohort with heart disease included greater risk of mortality score (OR 7.9), mechanical ventilation (OR 3.1), use of antiarrhythmics (OR 2.7), and use of vasoactive medications (OR 3.8). In the cohort without heart disease, factors associated with poor outcome included renal failure (OR 19.3), greater risk of mortality score (OR 4.2), use of antiarrhythmics (OR 3.8), and mechanical ventilation (OR 2.2). Median charge of hospitalization was $131,893 in the group without heart disease and $140,655 in the group with heart disease. CONCLUSION Infective endocarditis remains a significant cause of morbidity, mortality, and resource use particularly in children with heart disease.
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Affiliation(s)
- Adam L Ware
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Lloyd Y Tani
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Hsin-Yi Weng
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT
| | | | - Shaji C Menon
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT.
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Abstract
BACKGROUND New Zealand is a developed country with high incidence of bacterial infections and postinfectious sequelae including rheumatic heart disease. We sought to describe the clinical and microbiology features of children with infective endocarditis (IE) between 1994 and 2012. METHODS Retrospective review of patients <16 years identified from hospital records. RESULTS In total 85 episodes occurred in 82 children and 68 (80%) were classified as Definite IE and 17 as Possible IE according to modified Duke criteria. From Pacific Island countries, 13 cases were referred. There were 72 children who originated in New Zealand, of whom 52% were either indigenous New Zealand Maori or Pacific migrants. The median age at diagnosis was 7 (0-15) years. Of the 85 cases, 51 (60%) had congenital heart disease 10 children with rheumatic heart disease developed IE. Of the 85 cases, 35 (41%) met our criteria for healthcare-associated IE. 39/85 underwent surgery for IE. As direct result of IE, 4 (4.7%) children died and 9% of survivors had neurologic sequelae. Attributable in-hospital mortality was 4.7%. Staphylococcus aureus was the most common organism, accounting for 26 episodes (30.6%). Other notable pathogens included Corynebacterium diphtheriae (10 cases, 11.8%) and Streptococcus pyogenes (7 cases, 8.2%). In 6 episodes, the microbiologic diagnosis was made by 16S ribosomal RNA testing of excised cardiac tissue. CONCLUSIONS Congenital heart disease was the major risk factor for IE; however, rheumatic heart disease is also an important risk factor in New Zealand, with implications for local endocarditis prophylaxis recommendations. In addition to a high burden of healthcare-associated and staphylococcal IE, pathogens such as C. diphtheriae and S. pyogenes occurred. 16S ribosomal RNA testing is a useful tool to determine the etiologic agent in culture-negative IE.
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Changing spectrum of infective endocarditis in children: a 30 years experiences from a tertiary care center in Taiwan. Pediatr Infect Dis J 2014; 33:467-71. [PMID: 24378945 DOI: 10.1097/inf.0000000000000145] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The epidemiology of infective endocarditis (IE) changes with the medical advances. This study aimed to evaluate the trends in a pediatric cohort. METHODS From hospital database (1983-2011), patients <18 years who fulfilled the modified Duke criteria of IE were identified. RESULTS We enrolled 112 patients (M/F 57/55) with 116 IE episodes. About 86 patients (74.1%) had preexisting cardiac lesions and 23 patients (19.6%) were immunocompromised hosts. Prior dental procedure was noted in 12 (10.3%) patients, including 4 with simple ventricular septal defect. The overall mortality was 10.7%. The risk factors included vegetations in both ventricles (odds ratio = 7.81, P = .019) and prior use of broad-spectrum antibiotics (odds ratio = 3.75, P = .055). Approximately one-third of the patients (29.3%) required surgical intervention. We identified an increasing trend in the proportion of hospital-acquired IE (from 12% during 1983-1991 to 39% during 2002-2011), and the spectrum of offending pathogens showed a trend for fewer Streptococcus species, more Staphylococcus aureus and increased pathogen diversity. The leading pathogens were Gram-negative bacilli in hospital-acquired IE and Streptococcus species in community-acquired IE. Hospital-acquired IE was associated with younger age, a higher proportion of immunocompromised patients, a history of central line indwelling and higher mortality. In contrast, more surgical intervention and embolic events occurred in community-acquired IE patients. CONCLUSIONS The mortality of pediatric IE remains high. Dental procedures were noted in one-tenth of the patients. Although increased S. aureus-caused episodes and pathogen diversity were noted, Streptococcus species remain the most common pathogen.
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18
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Epidemiology of Candida Endocarditis. CURRENT FUNGAL INFECTION REPORTS 2013. [DOI: 10.1007/s12281-013-0158-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Marom D, Ashkenazi S, Samra Z, Birk E. Infective endocarditis in previously healthy children with structurally normal hearts. Pediatr Cardiol 2013; 34:1415-21. [PMID: 23483241 DOI: 10.1007/s00246-013-0665-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 02/09/2013] [Indexed: 12/20/2022]
Abstract
Structural heart disease, intravascular catheters, and invasive procedures are predisposing factors for infective endocarditis (IE). Data on IE in children with structurally normal hearts and no predisposing factors are limited. We aim to characterize IE (definite or possible by Duke criteria) in such a subgroup of pediatric patients (age <18 years) who were treated at our medical center. Of 51 events of IE in 50 children, 9 (18 %) had no predisposing factors. These infections were all community-acquired and presented with fever, a newly detected heart murmur, diagnostic echocardiographic findings, and left-sided infection. Clinical course was characterized by acute onset (n = 8 of 9) with a 100 % complication rate (heart failure or embolic phenomena). Emergency cardiac surgery was performed in 7 children (Ross surgery [n = 4], mitral valve replacement [MVR; n = 2], and valve repair [n = 1]). Causative organisms were S. aureus (n = 3), S. pneumoniae (n = 2), H. parainfluenzae (n = 1), and K. kingae (n = 1). In contrast, IE in children with predisposing factors (42 of 51 [82 %]) was frequently health care-associated (30 of 42), right-sided (20 of 42, p = 0.041), and with lower rates of diagnostic echocardiographic findings (28 of 42, p = 0.041), complications (16 of 42, p < 0.001), and surgical intervention (9 of 42, p = 0.002). Causative organisms were mainly viridans streptococci (n = 9), Candida species (n = 8), coagulase-negative staphylococci (n = 6), enteric Gram-negative bacilli (n = 6), S. aureus (n = 5), and K. kingae (n = 3). Mortality was 11 % in both groups. We conclude that pediatric IE in children with and without predisposing factors differs significantly. Due to the acute and complicated course of the latter, high awareness among pediatricians and prompt diagnosis are crucial.
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Affiliation(s)
- Daphna Marom
- Department of Pediatrics A, Schneider Children's Medical Center, Petach Tikva, Israel.
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20
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Fortún J, Centella T, Martín-Dávila P, Lamas MJ, Pérez-Caballero C, Fernández-Pineda L, Otheo E, Cobo J, Navas E, Pintado V, Loza E, Moreno S. Infective endocarditis in congenital heart disease: a frequent community-acquired complication. Infection 2012; 41:167-74. [PMID: 22956474 DOI: 10.1007/s15010-012-0326-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 08/20/2012] [Indexed: 12/28/2022]
Abstract
BACKGROUND Infective endocarditis (IE) is a severe complication in patients with congenital heart disease (CHD). Epidemiology, etiology, and outcome in this group are different to those of patients with acquired heart disease. METHODS We reviewed all cases of proven and probable IE (Duke's criteria) diagnosed in our center during the last two decades. RESULTS We observed 45 cases of IE in patients with CHD (age range 8 months to 35 years); these represented 5.5 % of all the episodes of IE in our institution during the study period. The most frequent CHD were ventricular septal defect (31 %), tetralogy of Fallot (19 %), and atrioventricular septal defect (11 %). Twenty cases of IE (44 %) were recorded in patients with non-corrected native-valve CHD. Of the 24 patients with prosthetic-valve IE, post-operative acquisition during the first 6 months was confirmed in 11 patients (range 4-110 days). IE was community-acquired in 62 % of cases. Streptococcus spp. were the most frequent etiologic agents (33 %), followed by Staphylococcus spp. (32 %). Surgery was required to treat IE in 47 % of patients (52 % in prosthetic-valve IE and 41 % in native-valve IE, p = ns). In comparison to native-valve IE, prosthetic-valve IE was significantly more nosocomial-acquired (61 vs. 14 %, p = 0.002), presented a higher heart failure rate at diagnosis (39 vs. 9 %, p = 0.035), and developed more breakthrough bacteremia episodes (19 vs. 0 %, p = 0.048). Global mortality was 24 % (75 % in patients with prosthetic-valve IE who required surgery and 0 % in patients with native-valve IE who required surgery, p = 0.001). Multivariate analysis excluding breakthrough bacteremia (100 % mortality in this condition) confirmed that nosocomial IE [odds ratio (OR), 23.7; 95 % confidence interval (CI), 2.3-239.9] and the presence of heart failure at diagnosis of IE (OR, 25.9; 95 % CI, 2.5-269.6) were independent factors associated with mortality. CONCLUSION Half of all cases of IE in patients with CHD occurred in patients with non-corrected native-valve CHD and two-thirds were community-acquired. Streptococcus spp. were the most frequent etiological agents. Patients with prosthetic-valve IE present a worse outcome, especially those requiring surgery. Breakthrough bacteremia, nosocomial IE, and heart failure are independent factors of mortality in patients with CHD presenting IE.
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Affiliation(s)
- J Fortún
- Infectious Diseases Department, Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal, Crtra Colmenar km 9,1, 28034, Madrid, Spain.
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21
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Lin YT, Hsieh KS, Chen YS, Huang IF, Cheng MF. Infective endocarditis in children without underlying heart disease. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2012; 46:121-8. [PMID: 22727890 DOI: 10.1016/j.jmii.2012.05.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 04/16/2012] [Accepted: 05/01/2012] [Indexed: 12/28/2022]
Abstract
BACKGROUND/PURPOSE Although pre-existing heart disease is the main predisposing factor for pediatric infective endocarditis (IE), cases of IE in children without underlying heart disease have been increasingly reported. This study reviews the clinical and laboratory characteristics of pediatric IE patients with and without underlying heart disease, and presents the unique features of patients with no apparent pre-existing heart disease. METHODS Children who were admitted to our hospital from January 1991 to April 2011 and met the Modified Duke criteria for definite or possible IE were retrospectively analyzed. Clinical characteristics and laboratory data were collected by chart review. RESULTS Forty-seven patients with a total of 48 episodes of IE were enrolled. Of these patients, 31 children (64.6%) had congenital heart disease (CHD), six (12.5%) had non-CHD chronic disease, and eleven (22.9%) were previously healthy adolescents. Five patients with non-CHD chronic conditions acquired infection from central catheter: two methicillin-resistant Staphylococcus aureus (MRSA), two Candida albicans and one coagulase-negative Staphylococcus (CoNS). The microbial pathogens in 11 previously healthy individuals were Streptococcus viridans (n = 3), methicillin-sensitive S. aureus (MSSA, n = 2), Haemophilus parainfluenzae (n = 2), Staphylococcus lugdunensis (n = 1), Enterococcus (n = 1), and Diphtheroid (n = 1). In total, five of 17 non-CHD patients were infected with S. aureus (two MRSA and three MSSA) and the vegetations in these five patients were detected in the right side of the heart (tricuspid valve or right atrium). The average interval between onset of symptoms and diagnosis of IE in the CHD and previously healthy groups was 18 and 31 days, respectively. Patients in the previously healthy group were older and more often required surgical interventions for removal of vegetation. CONCLUSION Over one-third (35.4%) of cases of IE in children occurred in patients without pre-existing cardiac disease. Early identification of these patients is critical and requires a high index of suspicion. The pathogenesis of IE in previously healthy individuals is still uncertain, but previous skin infection or dental problems may contribute to potential risk.
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Affiliation(s)
- Yen-Ting Lin
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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