Neurological events in children with infective endocarditis: Results from a prospective cohort

Abstract

Despite all improvements in diagnostic imaging and therapeutic modalities, Infective endocarditis (IE) remains a highly letal disease especially in children. Stroke is an uncommon complication of endocarditis in children but it is an major cause of acquired brain injury and is assiociated with a higher mortality rate. To determine the prevalence of neurological events in infective endocarditis among children in the Tunisian context. This was a prospective study that enrolled all children admitted for IE in the cardiology department of Monastir hospital between 1983 and 2017. Included Patients had definite IE based on the modified Ducke criteria. Fourty children with IE were identified, including 19 boys and 21 girls aged one to eighteen years. Sixteen (40%) had congenital heart disease. Left-sided IE occurred in 33 patients (82.5%), and vegetations were identified in 33 individuals (82.5%). The most often encountered microorganisms in our population were Streptococcus viridans and Staphylococcus aureus, which were identified in five and four patients, respectively. Stroke occurred in 9 patients, including five with cerebral infarction and three with intracerebral hemorrhage. The incidence of stroke in children with left-sided IE was significantly higher than in those with right-sided IE (17.5% vs. 2.5%, P < 0.001). The most common manifestation of stroke was hemiparesis (63%). The mortality in children with IE was 50%. The mortality rate in patients who had stroke was significantly higher than those who hadn’t (75% versus 35%, P = 0.05). Our study indicates that stroke is common among children with IE, especially in those with left-sided IE, and stroke may increase their risk of death.