Infective endocarditis in children

Abstract

Infective endocarditis (IE) in children is unfrequent but potentially serious. The aim of the present study was to describe our pediatric population and to highlight the differences with the adult population. In this retrospective monocentric cohort, 52 consecutive children with IE were included between January, 2000 and May, 2018. The median age was 9 [4-14] years. Thirty-two (61.5%) children had congenital cardiac disease among which 65% with ventricular septal defect (isolated or combined to another malformation). In the non-congenital group, 12 patients (23.1% of the entire cohort) had immune deficiency. Fever was the most frequent symptom (83%). A new or changed heart murmur was present in 16 children (31%), heart failure in 8 patients (15%). The aortic valve was affected in 14 children (27%), such was the mitral valve. Right-sided IE was frequent (18 children, 34%). There were 3 IE after MELODY valve implantation. Streptococci and Staphylococci were the most frequent bacteria (34%). The causal infective agent was not found in 8 patients (15%). One child died (septic shock), 21 patients (40%) had embolisms (6 cerebral, 8 pulmonary) with no difference between congenital heart disease and normal heart. Surgery was necessary for 24 children (46%) and more frequently required during the active phase for non-congenital children ( P < 0.05). There were 10 valvular replacements. Compared to adults studies, this monocentric cohort of IE in children revealed a high level of bacterial identification, a great proportion of immune deficiency and a high incidence of right-sided endocarditis.