Infectious endocarditis in children

Abstract

With the object of analyzing current characteristics of infectious endocarditis (IE) in children, we carried out a retrospective study of 23 cases of IE in children under 15 years of age seen at the Hospital Ramón y Cajal in Madrid (Spain) between 1977 and 1985. The incidence was high (1.3 cases per 1000 children admitted). The male/female ratio was 2:1. Eight patients were under 2 years of age and 15 over 2 years, the majority being adolescents. The two groups presented marked etiological and prognostic differences. Congenital heart disease was the predisposing factor in 20 of the 23 cases. Streptococcus viridans (nine cases) and Staphylococcus aureus (eight cases) were the most frequent organisms. Fourteen cases were on a native valve and nine were secondary (seven of these on prosthetic patches). In spite of advances in therapy, IE continues to be a severe illness: the mortality rate in our series was 26%. Factors associated with a poor prognosis were: age less than 2 years, Staphylococcus aureus as the causative agent, and the presence of prosthetic material.

Trends of Childhood Infective Endocarditis in Israel with Emphasis on Children Under 2 Years of Age

“…Similar trends were documented in other locations [5,13,17,22,23]. During the second part of the study period about half the patients were infected by microorganisms that uncommonly cause IE, such as C. albicans and P. aeruginosa, as has been reported in other studies [3,10,21]. Moreover, antibiotic resistance has been noted: of viridans streptococci to penicillin and of staphylococci to methicillin and other ␤-lactam antimicrobial agents ( Table 2).…”

“…This situation may have led to the delayed diagnosis [18] and high mortality [16,21] that have been reported. We did not observe a higher rate of complications in our group of young children, nor was there a high mortality rate.…”

“…Congenital rather than rheumatic heart disease has emerged as the frequent underlying disorder [2,3,14,21]. Concomitantly, the classic findings of ''subacute' endocarditis have become uncommon, partly because of a reduction in the cases caused by viridans streptococci, which typically exhibit the subacute insidious presentation [16,17,21,22].…”

Infective Endocarditis in Children With Congenital Heart Disease

“…Elevated IE risk in early childhood has been reported in studies of children with CHD, 11,28 and in children from the general population, as well, 12 and is probably multifactorial. Many patients undergo surgery for their CHD lesions early in life, which may reduce the IE risk, resulting in lower relative risk at older ages.…”

“…The population-based observations, availability of longitudinal data on patients, and the large size of the CHD cohort constitute major strengths of this work and a point of departure from other studies of IE, which relied on CHD patients from single institutions and referral centers to find lesions at high risk of IE, 27,31,32 on case series of patients with IE to determine frequency of CHD types, [17][18][19][20][21][22][23][24][25][26][27][28][29][30] or which analyzed hospital admissions for IE without longitudinal individual patients' data. 12,33,34 Although our data sources ensured the provincewide inclusion of children with CHD into the cohort, they are prone to misclassification error and lack clinical information, which can limit the validity and generalizability of the data.…”