Infective endocarditis in children

Van Der Merwe P.-L. ; Kalis N.N. (1994)


Infective endocarditis (IE) has high mortality and morbidity rates despite available treatment. Because of the changing predisposing cardiac abnormalities and causative organisms, a retrospective study of 29 children with this disease was undertaken to review our experience in its diagnosis and treatment. Forty-eight per cent of the patients presented with the classic clinical picture of IE. Rheumatic heart disease (69%) was the most common underlying cardiac condition. Sixty-five per cent of the blood cultures were negative, possibly because 82,5% of patients received antibiotic treatment before being referred to our institution. The organisms cultured were Staphylococcus aureus (3), S. epidermidis (2), Streptococcus viridans (2), S. faecalis (1), Pseudomonas (1) and Aeromonas (1). Two-dimensional echocardiography was found to be one of the most useful special investigations to confirm the diagnosis in children in whom IE was suspected. Despite early diagnosis and treatment, the mortality rate in this series was 24%, with serious complications occurring in a further 21% of patients. The value of having a committed individual to care postoperatively for children undergoing surgery for heart lesions cannot be overemphasised and might be an important factor in containing post-surgical IE.

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