Abstract
Infective endocarditis (IE) is an uncommon but life-threatening infection. Despite advances in management, it still causes high morbidity and mortality. We report the case of an 8-year-old girl who presented with a prolonged fever of 2.5 months duration and a history of a small perimembranous ventricular septal defect. She was diagnosed with subacute bacterial endocarditis secondary to Streptococcus mutans. The patient developed a septic pulmonary embolism; however, with the use of appropriate antimicrobial therapy, she made an uneventful recovery. Clinicians should have a high index of suspicion for IE as the possible cause of a prolonged fever, especially in the presence of congenital heart disease (CHD). Currently, IE prophylaxis is not indicated for unrepaired acyanotic CHD. Nevertheless, with the new changes in the guidelines, more prospective studies are needed to investigate the incidence of IE in such lesions, before long-term conclusions can be drawn.
Highlights
ONLINE CASE REPORTComplicated Subacute Bacterial Endocarditis in a Patient with Ventricular Septal Defect
Infective endocarditis (IE) is an uncommon but life-threatening infection
The classic presentation of IE includes fever, anaemia, positive blood cultures and heart murmur, all of which were present in our patient; there was a delay in the diagnosis despite the presence of the clinical and laboratory findings which were suggestive of subacute bacterial endocarditis (SBE)
Summary
Complicated Subacute Bacterial Endocarditis in a Patient with Ventricular Septal Defect. We report the case of an 8-year-old girl who presented with a prolonged fever of 2.5 months duration and a history of a small perimembranous ventricular septal defect She was diagnosed with subacute bacterial endocarditis secondary to Streptococcus mutans. Repaired and unrepaired congenital heart diseases (CHD) are associated with a high lifetime risk of IE; patients with ventricular septal defect (VSD) have the highest risk.[1] A VSD can present in an acute or subacute phase due to many organisms like the Streptococcus viridans group (S. mutans, S. mitis), and the Enterococcus and Staphylococcus species.[2] IE results from complex interactions between the microbial pathogen in the bloodstream, the matrix molecules and platelets at the sites of the endocardial cell damage. Diagnosis and prompt therapy can prevent the drastic complications which can ensue from IE
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