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Infective endocarditis as a form of late presentation of congenital heart disease. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2013. [DOI: 10.1016/j.repce.2013.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Vaz Silva P, Castro Marinho J, Martins P, Santos I, Pires A, Sousa G, Castela E. [Infective endocarditis as a form of late presentation of congenital heart disease]. Rev Port Cardiol 2013; 32:145-8. [PMID: 23347824 DOI: 10.1016/j.repc.2012.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 04/25/2012] [Accepted: 05/02/2012] [Indexed: 11/30/2022] Open
Abstract
A diagnosis of congenital heart disease is usually established at an early age, so infective endocarditis is a rare form of presentation. The authors describe the case of a male adolescent with a week-long history of intermittent fever and unquantified weight loss. Physical examination detected pansystolic and diastolic murmurs, and an associated precordial thrill. Laboratory tests showed evidence of an active infection. Etiological investigation revealed a perimembranous ventricular septal defect, aortic regurgitation, and aortic and mitral valve vegetations. A diagnosis of mitral-aortic infective endocarditis was made and he was started on intravenous antibiotics and anticongestive therapy. After initial clinical improvement, he developed symptoms and signs of congestive heart failure. Repeat echocardiography showed an extensive mitral-aortic paravalvular abscess. The antibiotics were changed and anticongestive therapy was intensified, and he subsequently underwent surgery. The outcome has been generally favorable, and at present he is asymptomatic under anticongestive therapy.
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Affiliation(s)
- Patrícia Vaz Silva
- Serviço de Cardiologia Pediátrica, Hospital Pediátrico Carmona da Mota, Coimbra, Portugal.
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Abstract
Fever in the postoperative period in children undergoing surgery for congenital heart disease is fairly common and tends to cause anxiety to both the surgeon and the patient. Such fever is associated with the metabolic response to trauma, systemic response to the cardiopulmonary bypass, hypothermia, presence of drainage tubes, drugs, blood transfusion as well as infections. Establishing the diagnosis requires proper assessment of the patient with focused history, targeted physical examination and judicious use of investigations with the knowledge of the common causes.
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Affiliation(s)
- Ajay K Gupta
- Department of Critical Care Medicine, Fortis Escorts Heart Institute, Okhla, New Delhi, India
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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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Infective endocarditis in congenital heart disease. Eur J Pediatr 2011; 170:1111-27. [PMID: 21773669 DOI: 10.1007/s00431-011-1520-8] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 06/10/2011] [Accepted: 06/15/2011] [Indexed: 10/18/2022]
Abstract
UNLABELLED Congenital heart disease (CHD) has become the leading risk factor for pediatric infective endocarditis (IE) in developed countries after the decline of rheumatic heart disease. Advances in catheter- and surgery-based cardiac interventions have rendered almost all types of CHD amenable to complete correction or at least palliation. Patient survival has increased, and a new patient population, referred to as adult CHD (ACHD) patients, has emerged. Implanted prosthetic material paves the way for cardiovascular device-related infections, but studies on the management of CHD-associated IE in the era of cardiovascular devices are scarce. The types of heart malformation (unrepaired, repaired, palliated) substantially differ in their lifetime risks for IE. Streptococci and staphylococci are the predominant pathogens. Right-sided IE is more frequently seen in patients with CHD. Relevant comorbidity caused by cardiac and extracardiac episode-related complications is high. Transesophageal echocardiography is recommended for more precise visualization of vegetations, especially in complex type of CHD in ACHD patients. Antimicrobial therapy and surgical management of IE remain challenging, but outcome of CHD-associated IE from the neonate to the adult is better than in other forms of IE. CONCLUSION Primary prevention of IE is vital and includes good dental health and skin hygiene; antibiotic prophylaxis is indicated only in high-risk patients undergoing oral mucosal procedures.
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Pediatric infective endocarditis: Has Staphylococcus aureus overtaken viridans group streptococci as the predominant etiological agent? CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2011; 19:63-8. [PMID: 19145264 DOI: 10.1155/2008/867342] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Accepted: 10/30/2007] [Indexed: 02/06/2023]
Abstract
BACKGROUND Viridans group streptococci (VGS) have traditionally been the most common etiological agents of infective endocarditis (IE). Advances in cardiovascular surgery and the increasing use of long-term central venous catheters may have altered the epidemiology of pediatric IE. METHODS A chart review of children younger than 17 years of age with IE was completed at the Stollery Children's Hospital (Edmonton, Alberta) between 1985 and 2004. The literature was reviewed to look for changes over time in the most common etiological agents of pediatric IE. RESULTS There were 31 cases of definite IE and nine cases of possible IE at the Stollery Children's Hospital, 19 of which were nosocomial. Thirty cases (75%) had congenital heart disease. The etiological agents were Staphylocccus aureus (n=16), VGS (n=5), coagulase-negative staphylococci (n=3), enterococcus (n=3), other streptococci (n=8), Enterobacter cloacae (n=1) and Stenotrophomonas maltophilia (n=1), while three cases were culture negative. Two deaths were due to S aureus IE. Review of the literature identified an increasing number of case series in which S aureus was the predominant etiological agent, but VGS still predominated in some recent series. CONCLUSION Congenital heart disease remains the primary risk factor for pediatric IE. Prospective population-based studies are required to determine whether S aureus has become the predominant pathogen.
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Blumental S, Reynders M, Willems A, Biarent D, Duttman R, Lepage P, Vergison A. Enteroviral Infection of a Cardiac Prosthetic Device. Clin Infect Dis 2011; 52:710-6. [DOI: 10.1093/cid/ciq189] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Rosenthal LB, Feja KN, Levasseur SM, Alba LR, Gersony W, Saiman L. The changing epidemiology of pediatric endocarditis at a children's hospital over seven decades. Pediatr Cardiol 2010; 31:813-20. [PMID: 20414646 PMCID: PMC2997359 DOI: 10.1007/s00246-010-9709-6] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Accepted: 04/01/2010] [Indexed: 01/23/2023]
Abstract
This study sought to determine whether improvements in the care of children with congenital heart disease (CHD) have changed the epidemiology of infective endocarditis (IE). A retrospective study of patients 18 years of age and younger treated for IE from 1992 to 2004 (era 3) was conducted at the authors' children's hospital in New York City. This study was compared with two previous studies conducted at the same hospital from 1930 to 1959 (era 1) and from 1977 to 1992 (era 2). During the three eras, IE was diagnosed for 205 children with a median age of 8 years during eras 1 and 2, which decreased to 1.5 years during era 3, partly because of IE after cardiac surgery for young infants. In era 3, nonstreptococcal and nonstaphylococcal pathogens associated with hospital-acquired IE increased. Complications from IE declined during era 3, but after the widespread availability of antibiotics in 1944, crude mortality rates were similar in eras 1 (32%), 2 (21%), and 3 (24%). However, in era 3, mortality occurred only among subjects with hospital-acquired IE. The epidemiology of pediatric IE has changed in the modern era. Currently, IE is most likely to occur among young children with complex congenital heart disease. Pediatric IE remains associated with high crude mortality rates when it is acquired in the hospital.
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Affiliation(s)
- Lauren B. Rosenthal
- Morgan Stanley Children's Hospital of NewYork-Presbyterian, New York, NY, USA
| | - Kristina N. Feja
- Morgan Stanley Children's Hospital of NewYork-Presbyterian, New York, NY, USA, Department of Epidemiology, University of Medicine and, Dentistry of New Jersey, Piscataway, NJ, USA
| | - Stéphanie M. Levasseur
- Morgan Stanley Children's Hospital of NewYork-Presbyterian, New York, NY, USA, Department of Pediatrics, Columbia University, 622 West 168th Street, New York, NY 10032, USA
| | - Luis R. Alba
- Department of Pediatrics, Columbia University, 622 West 168th Street, New York, NY 10032, USA
| | - Welton Gersony
- Morgan Stanley Children's Hospital of NewYork-Presbyterian, New York, NY, USA, Department of Pediatrics, Columbia University, 622 West 168th Street, New York, NY 10032, USA
| | - Lisa Saiman
- Morgan Stanley Children's Hospital of NewYork-Presbyterian, New York, NY, USA, Department of Pediatrics, Columbia University, 622 West 168th Street, New York, NY 10032, USA, Department of Epidemiology, NewYork-Presbyterian Hospital, New York, NY, USA
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Mahar T, Katzman P, Alfieris G. A case of fatal septic pulmonary embolus arising from an infected Sano conduit. Pediatr Cardiol 2009; 30:181-3. [PMID: 18654812 DOI: 10.1007/s00246-008-9276-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2008] [Revised: 06/23/2008] [Accepted: 07/07/2008] [Indexed: 11/26/2022]
Abstract
A 5-month-old boy who had previously undergone a modified Norwood procedure for hypoplastic left heart syndrome presented for elective cardiac catheterization before undergoing the next stage of repair. The catheterization demonstrated mild stenosis of the right ventricle-to-pulmonary artery Sano conduit. The patient became hypoxic and febrile at the end of the procedure and died in the intensive care unit the next day. Postmortem examination demonstrated a vegetation containing Gram-positive cocci in the conduit and a right upper lobe lung abscess also containing Gram-positive cocci. The authors report the first case of Sano shunt endocarditis further complicated by septic pulmonary embolus and review similar infections in this population. Shunt infection may be an underrecognized cause of interstage mortality among patients undergoing a modified Norwood procedure.
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Affiliation(s)
- Tara Mahar
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 626, Rochester, NY 14642, USA.
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Di Filippo S, Delahaye F, Semiond B, Celard M, Henaine R, Ninet J, Sassolas F, Bozio A. Current patterns of infective endocarditis in congenital heart disease. Heart 2006; 92:1490-5. [PMID: 16818488 PMCID: PMC1861050 DOI: 10.1136/hrt.2005.085332] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2006] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To assess the changing profile of infective endocarditis in patients with congenital heart disease. METHODS All cases diagnosed from 1966 to 2001 (revised Duke criteria) were retrospectively reviewed and categorised in periods I (< 1990) and II (>or= 1990). RESULTS 153 episodes occurred, 81 in period I and 72 in period II. Mean age of affected patients was higher in period II. Non-operated ventricular septal defect, Rastelli correction and palliated cyanotic heart disease increased. Infective endocarditis in corrective surgery changed to patients with prosthetic material. Post-surgical cases decreased. Dental problems were the leading cause (period I 20% v II 33% of cases) with a large variety of pathological organisms (multiple species of Streptococcus). Cutaneous causative infections increased (5% to 17%) with different species of Staphylococcus. Negative blood cultures lessened (20% to 7%, p = 0.03). Streptococci were the most common causative organisms in both periods. Severe heart failure and cardiac complications lessened (20% to 4% and 31% to 18% during periods I and II, respectively). Early surgery was more frequent in period II (32% v 18.5%, p = 0.02). One- and 10-year survival was 91% v 97% in period I and 89% v 97% in period II, respectively (NS). CONCLUSION Current targets include complex cyanotic disease, congenital heart disease corrected with prosthetic material and small ventricular septal defect. Postoperative cases lessened; dental and cutaneous causes increased. Survival was unchanged. Prophylactic measures targeted at dental and cutaneous sources should be emphasised.
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Affiliation(s)
- S Di Filippo
- Cardiologie Pediatrique, Hopital L Pradel, Lyons, France.
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Chatzis AC, Saroglou G, Giannopoulos NM, Sarris GE. Subtle infective endocarditis and congenital cardiac disease. Cardiol Young 2005; 15:617-20. [PMID: 16297256 DOI: 10.1017/s1047951105001794] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2005] [Indexed: 11/06/2022]
Abstract
Congenital cardiac disease is recognized as a major predisposing substrate for infective endocarditis. We present three cases of unanticipated intraoperative discovery of vegetations in patients with congenital cardiac malformations without preoperative clinical, laboratory or echocardiographic evidence of infective endocarditis, and their successful treatment. The relevant literature is reviewed, with emphasis of the need to maintain a high index of suspicion for the presence of endocarditis during repair of congenital cardiac lesions.
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Affiliation(s)
- Andrew C Chatzis
- Department of Paediatric and Congenital Cardiac Surgery, Onassis Cardiac Surgery Centre, University of Athens, Athens, Greece.
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Niwa K, Nakazawa M, Tateno S, Yoshinaga M, Terai M. Infective endocarditis in congenital heart disease: Japanese national collaboration study. Heart 2005; 91:795-800. [PMID: 15894782 PMCID: PMC1768964 DOI: 10.1136/hrt.2004.043323] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To provide pure cohorts of paediatric and adult patients with congenital heart disease (CHD) and infective endocarditis (IE) for making future guidelines. DESIGN Japanese nationwide survey. SETTING 66 Japanese institutions. PATIENTS 170 children, mean (SD) age 7.4 (5.7) years (range 14 days to 17 years), and 69 adults, age 32.5 (14.1) years (range 18-69) who developed IE between 1997 and 2001 (one in 240 admissions with CHD). MAIN OUTCOME MEASURES Clinical presentation of IE. RESULTS 119 patients including 88 with cyanotic CHD had previous cardiac surgery. Procedures preceding IE were dental (12%) followed by cardiovascular surgery (8%). Sites of infection were left sided in 46% and right sided in 51%. Vegetation with diameter of 11 mm was documented in 151 (63%). Frequent complications were embolic events (stroke 11%, other emboli 20%) and cardiac failure (23%). The most common microorganisms were streptococci (50%) and staphylococci (37%) with methicillin resistant Staphylococcus aureus in 7.5%. Empirical treatments were penicillins (alone or with other antibiotics 57%) followed by cephems (22%) and vancomycin (11%). Surgery during active IE was common (26%), with vegetation (45%) and heart failure (29%) as the most frequent indications. Mortality was 8.8%: 8.0% among patients who received medical treatment alone and 11.1% among those with active IE who underwent surgery. The causes of death (n = 21) were surgery (7), infection (7), cardiac failure (6), and renal failure (1). CONCLUSIONS Because of a recent increase in the incidence of IE and high mortality and complication rate, it is mandatory to establish well formulated recommendations for management of IE in paediatric and adult patients with CHD based on a large cohort. Results of this nationwide multicentre database should be helpful in establishing guidelines.
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Affiliation(s)
- K Niwa
- Department of Paediatrics, Chiba Cardiovascular Centre, Ichihara, Chiba, Japan.
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Steelman R, Rosen DA, Nelson ER, Kenamond LA. Gingival colonization with selective HACEK microbes in children with congenital heart disease. Clin Oral Investig 2003; 7:38-40. [PMID: 12673436 DOI: 10.1007/s00784-003-0199-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2002] [Accepted: 02/04/2003] [Indexed: 10/25/2022]
Abstract
It was previously shown that children with congenital heart disease (CHD) harbored Hemophilus, Actinobacillus, Cardiobacter, Eikenella, and Kingella (HACEK) microbes to a greater extent and had more severe gingival inflammation than a normal group of children. The purpose of this study was to determine if HACEK microbes are more prevalent in children with CHD than in normal children when there is no difference in gingival inflammation. Two groups of 12 children were matched with respect to gingival inflammation. Each child had a gingival index recorded as described by Massler. The experimental group consisted of 12 children with CHD 2.5-10 years old (average 5.5) and the control group consisted of 12 healthy children 2-13 years old (average 5.6). Subgingival samples were obtained and cultured for HACEK microbes. Fischer's exact test was performed with the significance level defined at P<0.05. The average gingival indices for the experimental and control groups were 6.5 and 6.4, respectively (N.S.). Nine of 12 children with CHD had Eikenella corrodens (E.c.) compared to 3/12 control patients ( P<0.05). Three of 12 CHD patients but no control patient had Actinobacillus actinomycetemcomitans (A.a.) (N.S.). There were no significant differences in E.c. or A.a. presence between cyanotic and acyanotic CHD patients. This study found that the greater extent of specific HACEK microbes harbored by children with CHD is not associated with cyanosis or the degree of gingival inflammation. Further study is needed to delineate fully the medical significance of this observation.
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Affiliation(s)
- Robert Steelman
- Department of Pediatrics, School of Medicine, Oregon Health and Science University, Portland, Oregon 97201, USA.
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Ferrieri P, Gewitz MH, Gerber MA, Newburger JW, Dajani AS, Shulman ST, Wilson W, Bolger AF, Bayer A, Levison ME, Pallasch TJ, Gage TW, Taubert KA. Unique features of infective endocarditis in childhood. Pediatrics 2002; 109:931-43. [PMID: 11986458 DOI: 10.1542/peds.109.5.931] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Patricia Ferrieri
- Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association
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Ferrieri P, Gewitz MH, Gerber MA, Newburger JW, Dajani AS, Shulman ST, Wilson W, Bolger AF, Bayer A, Levison ME, Pallasch TJ, Gage TW, Taubert KA. Unique features of infective endocarditis in childhood. Circulation 2002; 105:2115-26. [PMID: 11980694 DOI: 10.1161/01.cir.0000013073.22415.90] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Chaturvedi R, de Leval M, Sullivan ID. Urgent homograft aortic root replacement for aortic root abscess in infants and children. Heart 1999; 81:62-6. [PMID: 10220547 PMCID: PMC1728894 DOI: 10.1136/hrt.81.1.62] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess the results of early homograft aortic root replacement in infants and children with an aortic root abscess. DESIGN Descriptive study of all patients with an aortic root abscess during 1987-97, identified by retrospective review of the echocardiographic and surgical registries. SETTING A tertiary referral centre. PATIENTS Five patients (age 0.6 to 13 years; two female) were identified with an aortic root abscess. Four had no known pre-existing congenital heart abnormality. Three had a misleading presentation and were referred to our hospital with non-cardiac diagnoses (fulminant hepatic failure; adult respiratory distress syndrome; cerebrovascular accident). The other two presented with septicaemia and a murmur, respectively. Blood cultures identified Staphylococcus aureus (n = 3) and Streptococcus pneumoniae (n = 2). Aortic root abscess was diagnosed by transthoracic echocardiography. INTERVENTIONS Homograft aortic root replacement with coronary reimplantation was performed urgently (median one day after diagnosis). RESULTS Four patients survived. The youngest died following multiorgan failure, multiple aortic fistulae, three valve involvement, and extensive tissue destruction preventing mitral valve replacement (S pneumoniae). Two of the four survivors have required further surgery: mitral valve replacement (0.3 years later), and pulmonary autograft replacement of the homograft (8.3 years later). All survivors remain in sinus rhythm and New York Heart Association functional class I. CONCLUSIONS Infective endocarditis should be considered in any child with severe septicaemia or embolic phenomena. Echocardiographic diagnosis of an aortic root abscess indicates uncontrolled infection and impending haemodynamic collapse. Homograft aortic root replacement can be performed successfully in critically ill children with active infection.
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Affiliation(s)
- R Chaturvedi
- Great Ormond Street Hospital for Children NHS Trust, London WC1N 3JH, UK
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Di Filippo S, Sassolas F, Bozio A. [Prevention of infective endocarditis in the child. Current status and protocols]. Arch Pediatr 1998; 5:785-92. [PMID: 9759280 DOI: 10.1016/s0929-693x(98)80069-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Infective endocarditis remains a severe, potentially lethal disease, which justifies a rigorous prevention schedule. Children with cyanotic congenital heart disease, mitroaortic valvulopathies, prosthetic valve and uncorrected ventricular septal defect are the most susceptible. Dental care is the main cause of bacterial graft, followed by upper respiratory tract and cutaneous infections. Prevention is mainly based upon antibiotic prophylaxis but patient education and good dental hygiene are also important.
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Affiliation(s)
- S Di Filippo
- Service de cardiologie pédiatrique, hôpital cardiovasculaire et pneumologique Louis-Pradel, Lyon, France
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Dhawan A, Grover A, Marwaha RK, Khattri HN, Anand IS, Kumar L, Walia BN, Bidwai PS. Infective endocarditis in children: profile in a developing country. ANNALS OF TROPICAL PAEDIATRICS 1993; 13:189-94. [PMID: 7687116 DOI: 10.1080/02724936.1993.11747644] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
With the object of studying the profile of infective endocarditis in Indian children younger than 16 years of age, a retrospective study of 37 patients with infective endocarditis admitted to this hospital between January 1984 and December 1990 was carried out. There were 26 boys and 11 girls (aged 2-16 years (mean (SD) 10.3 (3.8)). Eighteen (48.6%) patients had underlying congenital heart disease, 13 (35.1%) had associated rheumatic heart disease whilst the remaining six had no pre-existing heart disease. All six patients with a normal heart and infective endocarditis had preceding extra-cardiac bacterial illnesses (epididymitis and orchitis in one, pneumonia in five). Blood cultures were positive in only 16 (43.2%): Staphylococcus aureus was grown in nine, Streptococcus viridans in six and Candida albicans in one. Sixteen (43.2%) of the 37 patients died owing to worsening cardiovascular haemodynamics, uncontrolled septicaemia and our inability to offer emergency surgery. The profile of infective endocarditis in developing countries is different from that in Europe and the United States of America, and the disease carries a very high mortality.
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Affiliation(s)
- A Dhawan
- Department of Paediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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De Gevigney G, Delahaye J. Risque d'endocardite infectieuse après intervention intracardiaque. Med Mal Infect 1992. [DOI: 10.1016/s0399-077x(05)80527-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
Infective endocarditis occurs infrequently in the general pediatric population, occurring mostly in patients with congenital heart disease. This study reviews our surgical experience with infective endocarditis based on a policy of aggressive intervention, conservative operative debridement, and creative reconstruction options using pericardium and prosthetic heart valves. From 1982 to 1989, 16 patients, 3 weeks to 16 years of age, underwent 19 intracardiac operations for infective endocarditis therapy at Kosair Children's Hospital. Eight (42%) were for resection of vegetations alone; an additional 11 operations (58%) involved more extensive debridements requiring either valve replacement or valvuloplasty using pericardium for exclusion of an abscess cavity, closure of a fistula, or for valve repair. Operative mortality was 25% (4 patients) and related to preoperative disease severity. There was one late death. Offending organisms included Staphylococcus species (31%), Haemophilus influenzae (13%), pneumococcus (5%), gram-negative organisms (13%), and Candida (13%); no organism grew on culture in 25%. We conclude that aggressive surgical exploration in patients with infective endocarditis is indicated and often requires resection of vegetations alone. More extensive procedures should preserve as much valvular tissue as possible. Pericardium is useful for reconstruction after debridement.
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Affiliation(s)
- M Citak
- Department of Surgery, University of Louisville, Kentucky
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22
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Hansen D, Schmiegelow K, Jacobsen JR. Bacterial endocarditis in children: trends in its diagnosis, course, and prognosis. Pediatr Cardiol 1992; 13:198-203. [PMID: 1518737 DOI: 10.1007/bf00838776] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In a population-based study of 41 children with bacterial endocarditis (BE), diagnosed in the period 1970 through 1989 in eastern Denmark, we analyzed trends in the diagnosis of BE and in mortality, and searched for possible prognostic factors. During this period the delay in diagnosis from first symptom to treatment did not change, but the delay from admission to treatment was significantly prolonged from 0 to 3 days, despite the introduction of echocardiography (ECHO). There was a significant improvement in the prognosis, the mortality rate having decreased from 40 to 0% [95% confidence limits: 12-74 vs. 0-26 (0.01 less than p less than 0.02)]. The improved prognosis was not explained by changes in the etiology or pattern of antibiotic resistance and may reflect a milder course of BE in children. Children with "mild anomalies"--such as bicuspid aortic valve (n = 5), coarctation of the aorta (n = 2), and prolapse of the mitral valve (n = 2)--had a significantly poorer prognosis than children with other forms of congenital heart disease (CHD) (p = 0.004), a reminder of the importance of suspecting BE in all children with unexplained long-lasting or intermittent fever, because some may have unrecognized "mild" CHD.
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Affiliation(s)
- D Hansen
- Department of Paediatrics, University Hospital of Copenhagen, Denmark
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23
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Parsons JM, Martin RP, Smith RR. Infective endarteritis affecting the left pulmonary artery after anatomical correction of complete transposition of the great arteries. BRITISH HEART JOURNAL 1988; 60:78-80. [PMID: 3408621 PMCID: PMC1216519 DOI: 10.1136/hrt.60.1.78] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Clinical features of infective endocarditis developed in a two year old boy. He had successfully undergone anatomical correction of complete transposition of the great arteries during the neonatal period. At routine investigation one year later he showed evidence of important supravalvar pulmonary stenosis. He remained symptom free until endocarditis developed. Streptococcus pneumoniae was isolated from serial blood cultures. Despite prompt treatment with specific intravenous antibiotic treatment the patient died of overwhelming sepsis. At necropsy the stenosed portion of the left pulmonary artery was seen to be the site of infection.
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Affiliation(s)
- J M Parsons
- Paediatric Surgical Unit, Harefield Hospital, Middlesex
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