Clinical Presentation and Outcome of Infective Endocarditis in Childhood

Park, A Ram; Kim, Byung Ju; Ma, Jae Sook

Abstract

Infective endocarditis (IE) remains an important cause of morbidity and mortality in children with structural heart disease. We reviewed 15 children cases of IE to identify the recent changes in the pattern of clinical spectrum, causative organisms, and outcome. Duke criteria was applied for the diagnosis. Cases were categorized into group I and II; 9 patients with IE developed in children with no previous cardiac surgery were classified as Group I, 6 patients with IE developed in children with history of previous cardiac surgery as Group II. There were 5 boys and 10 girls whose average age was 7.1 +/- 5.6 years. Preexisting heart diseases were identified in 13 cases (86.7%); ventricular septal defect was identified in 7 cases, being the most common structural heart disease. Causative organisms were identified in 7 cases (46.7%); Staphylococcus aureus was most commonly identified. Among the 15 cases of IE, preexisting events were identified in 9 cases (60%). Fever was the most frequent symptom appeared in 14 cases (93%). Hepatomegaly (60%) was the most common sign appeared in 9 cases, followed by new cardiac murmur in 6 cases (40%). On laboratory findings, anemia (66.7%) and thrombocytopenia (20%) were presented. Vegetation was detected in 13 cases (86.7%) and the mitral valve was the most frequent site (5 cases). Complications were detected in 13 cases (86.7%); central nervous system complications were most commonly identified (9 cases). The overall mortality rate was 46.7%. Mortality in the group with only medical treatment was higher than that with medical and surgical treatment (60% versus 20%). Despite the intensive treatment and prophylaxis, the mortality and morbidity of infective endocarditis has been remained still high in children. A more aggressive application of operative management may be recommanded for the treatment.