Neurological events in children's infective endocarditis: A prospective cohort

Abstract

Despite all improvements in diagnostic imaging modalities and therapeutic regimens, Infective endocarditis remains a lethal disease especially in children. Stroke is an uncommon complication of endocarditis in children but it is an important cause of acquired brain injury which is associated with a higher mortality rate. This was a prospective study that included all children diagnosed with infective endocarditis (IE) and hospitalized in the cardiology department of Monastir hospital between 1983 and 2017. We included patients who were diagnosed with definite infective endocarditis based on the modified Ducke criteria. Forty children with infective endocarditis were identified, including 19 boys and 21 girls aged Twelve months to eighteen years sixteen (40%) of these individuals had congenital heart disease. Left-sided endocarditis occurred in 33 patients (82.5%), and vegetations were found in 33 individuals (82.5%). The most often encountered micro-organisms in our population were Streptococcus viridans and Staphylococcus aureus, which were identified in five and four patients, respectively. Postendocarditis stroke occurred in 9 patients, including five with cerebral infarction, three with intracerebral hemorrhage and one with pulmonary infraction. The incidence of stroke in children with left-sided endocarditis was significantly higher than those with right-sided endocarditis (17.5% versus 2.5%, P < 0.01). The most common manifestation of stroke was hemiparesis (63%). The mortality in children with endocarditis was important (50%). The mortality rate in patients who had stroke was significantly higher than those who had not (75% versus 35%, P < 0.05). Our study indicates that stroke is common among children with infective endocarditis, especially in those with left-sided endocarditis, and major stroke may increase their risk of death.