INFECTIVE ENDOCARDITIS IN CHILDHOOD
Roodpeyma S.
Department of pediatrics, Taleghani Hospital, Shaheed Beheshti
University of Medical Scineces, Tehran, Iran
Objectives: Our aim was to
evaluate the nature of underlying heart disease, the type of responsible
organism, and prognosis of infective endocarditis in a group of
hospitalized children.
Methods: The medical records
of all the 23 patients with discharge diagnosis of infective endocarditis
in the pediatric department of Taleghani Hospital during a period of 10
years (1988-1998) were reviewed.
The diagnosis of infective endocarditis was verified either by
positive blood culture, detection of vegetation on echocardiography or by
both.
Results: The mean age of the
patients was 7.5 years (range 6 months to 12 years). There were 12 (52.2%)
girls and 11 (47.8%) boys. Acyanotic congential heart disease was the most
common underlying lesion, occuring in 20 (87%) children, including VSD in 9
(39.3%), PDA in 6 (26%), AS in 4 (17.4%), and PS in 1 (4.3%) patient. Three
patients (13%) had rheumatic valvular disease. Blood cultures were positive
in 12 (52.2%) patients. Of 12 culture-postive cases, Streptococcus viridans
was isolated in 6 patients all of them admitted during the 1st 5 years of
study, Staphylococcus aureus in 5 patients all of them were admitted in the
2nd 5 years. In 1 case Kelebsiella was isolated. Echocardiography revealed
vegetation in 17 (74%) patients. In six patients (26%) both blood
culture and echocardiographic
findings were positive. Four
cases (17.4%) acquired infection after heart surgery and two of them with
aortic stenosis died. The total mortality rate was 13% (3 cases).
Conclusions: The frequent
involvement of acyanotic heart lesions, the increasing prevalance of
Staphylococcus aureus, and the ominous prognosis of postoperative
endocarditis and aortic value involvement are evident in this study.