Infective Endocarditis In Children Research Articles

Are We Seeing a Change in the Microbiological Pattern of Infective Endocarditis in Children?

Are We Seeing a Change in the Microbiological Pattern of Infective Endocarditis in Children?

Epidemiological, Bacteriological, and Evolutive Features of Children Hospitalized for Infective Endocarditis in a Tertiary Tunisian Pediatric Department.

Infective endocarditis is a rare condition in childhood, and there is limited data on this disease in Tunisia. This study aims to analyze the epidemiological profile, bacteriological data, and prognosis of infective endocarditis in children admitted to the pediatric department of a University Hospital in Tunisia. We conducted a comparative cross-sectional study in the pediatric department of Sahloul Teaching Hospital in Sousse, a tertiary referral hospital in Tunisia. The study included all children aged ≤ 18 years with infective endocarditis admitted to the tertiary referral center for pediatrics in Sahloul University Hospital from January 1994 to December 2022. The diagnosis of infective endocarditis was based on modified Duke's criteria. Thirty-six patients met the diagnostic criteria for infective endocarditis, resulting in a proportion of 07 cases per 1000 hospital admissions. The mean age was 6 years (range: 40 days to 16 years). Congenital heart disease was identified as the underlying lesion in 23 cases (63.9 %). Blood cultures were positive in 20 patients (55.6 %), predominantly with Staphylococcus species (55 %). The most frequent complications involved the central nervous system (8 cases; 22.2 %). The mortality rate was 25 %, and factors predicting mortality included heart failure on admission or during the hospital stay, increased leukocyte count, and decreased prothrombin time. Our study reveals a shift in the prevalent underlying lesions, with rheumatic heart diseases no longer being the most common. Staphylococcus spp. emerged as the predominant organism in blood cultures. Notably, mortality predictors included heart failure, an elevated leukocyte count, and a decreased prothrombin time rate.

Changes in the Etiological Structure and Specifics When Choosing Antibacterial Therapy Against Infective Endocarditis in Pediatric Practice

Infective endocarditis in children is a rare disease, which often has an extremely serious prognosis. The most common risk factor for infective endocarditis in this category of patients is the history of congenital heart disease. At the same time, currently, the disruption of the integrity of the peripheral vascular bed is increasingly noted, among the predisposing causes, due to invasive diagnostic and therapeutic medical procedures, as well as severe somatic diseases. In accordance with the developed recommendations, the appointment of antibacterial therapy for infective endocarditis should be based on etiotropic orientation. Taking these circumstances into account, the article presents an overview of the data reflecting the issues of etiology and choice of antibacterial therapy for infective endocarditis in pediatric practice.

Surgical results of heart valve disease because of bacteriological endocarditis in children at hanoi heart hospital

Objective: Review of some clinical and paraclinical characteristics and evaluation of outcomes after surgical treatment of valvular heart disease due to infective endocarditis in children at Hanoi Heart Hospital
 Methods: Analysis and evaluation based on data collected from patients undergoing surgery and from the results of follow-up examination.[1]
 Results: The total number of patients was 25. Average age of surgery: 6,56 ± 7.05 years (The lowest age is 1years, the highest is 15 years). Male: 14 patients (56%), female: 11 patients 44(%). Ultrasound before discharge and after 3 months, we found similar results: mean EF:57,25 ± 9,68 %; Mean pressure through mitral valve: 3,5 ± 1,5mmHg; through aortic valve: 12,5 ± 1,68mmHg. Complications: Death immediately after surgery: 0 cases (0%); Late death: there was 1 case of death (4%).
 Conclusion: Results of surgery for valvular heart disease due to infective endocarditis in children are positive. The rate of mortality and complications after surgery is low.

Infective Endocarditis at a Referral Children's Hospital During 19-Year Period: Trends and Outcomes.

We noted a recent increase in cases of infective endocarditis (IE) at our institution. The purpose of the study is to examine the incidence, risk factors, microbiology and outcome of IE in our pediatric population. Retrospective review of IE cases during 2002-2020 at Children's Hospital of Michigan, Detroit. 68 patients with IE were identified. There was a 2-fold increase in incidence during the 2012-2020 (late period) compared to the 2002-2011 (early period). The most common predisposing conditions were congenital heart disease (CHD) in 39 (57.4%) and central venous catheter (CVC) in 19 (27.9%). CHD was more frequent in the late period (29/43, 67.4%) compared to early period (10/25, 40.0%) (p = 0.042). In CHD patients, palliative or corrective cardiac surgery was performed prior to IE diagnosis in 4/25 (16%) in early period and 23/43 (53.5%) in the late period (p = 0.004). S. aureus was the most common causative organism (35.3%) followed by streptococci (22.1%). Valve replacement or valvuloplasty was performed in 22.1% of patients. Complications occurred in 20 (29.4%). Mortality occurred in 7 (10.3%): 3 had CHD, 3 had CVC and underlying conditions and 1 had fulminant MRSA infection. The higher incidence of IE during the late period is likely due to an increase in patients with CHD who had undergone prior cardiac surgery. S. aureus was the predominant pathogen in all patients including those with CHD, followed by streptococci. IE in children continues to be associated with high rates of morbidity and mortality.

Aortic Valve Surgery in Children With Infective Endocarditis

There are limited data on the outcomes of children who undergo surgery for aortic valve infective endocarditis (IE), and the optimal surgical approach remains controversial. This study investigated the long-term outcomes of surgery for aortic valve IE in children, with a particular focus on the Ross procedure.

Case report: right sided endocarditis in pediatric patient after surgical treatment of tetralogy Fallot

Right-side endocarditis is a well-defined clinical entity, rarer than left-side endocarditis. Infective endocarditis in children has multiple challenges. A history of congenital heart disease is the most common risk factor, although other emerging predisposing conditions have important relevance. We report the clinical presentation, diagnosis and management in a pediatric patient with isolated native pulmonary valve endocarditis one year after surgical treatment of Tetralogy Fallot.

Aortic Valve Surgery in Children With Infective Endocarditis

There is limited data on the outcomes of children who undergo surgery for aortic valve infective endocarditis (IE), and the optimal surgical approach remains controversial. We investigated the long-term outcomes of surgery for aortic valve IE in children, with a particular focus on the Ross procedure. A retrospective review of all children who underwent surgery for aortic valve IE was performed at a single institution. Between 1989 and 2020, 41 children underwent surgery for aortic valve IE, of whom 16 (39.0%) underwent valve repair, 13 (31.7%) underwent the Ross procedure, 9 (21.9%) underwent a homograft root replacement, and 3 (7.3%) underwent a mechanical valve replacement. Median age was 10.1 years (interquartile range, 5.4-14.1). The majority of children (82.9%, 34/41) had underlying congenital heart disease, while 39.0% (16/41) had previous heart surgery. Operative mortality was 0.0% (0/16) for repair, 15.4% (2/13) for the Ross procedure, 33.3% (3/9) for homograft root replacement, and 33.3% (1/3) for mechanical replacement. Survival at 10 years was 87.5% for repair, 74.1% for Ross, and 66.7% for homograft (P > 0.05). Freedom from reoperation at 10 years was 30.8% for repair, 63.0% for Ross, and 26.3% for homograft (P=0.15 for Ross vs repair, P=0.002 for Ross vs homograft). Children undergoing surgery for aortic valve IE have acceptable long-term survival, although the need for long-term reintervention is significant. The Ross procedure appears to be the optimal choice when repair is not feasible.

Unique Clinical Manifestation of Infective Endocarditis in Children: A Case Series

BACKGROUND: Infective endocarditis (IE) was a significant cause of morbidity and mortality, particularly in children with congenital heart disease (CHD). Infective endocarditis could occur in all ages with higher in children below 1-year-old, including neonates. Various clinical manifestations of IE in children make it difficult to make a prompt diagnosis and appropriate management. Finding in echocardiography could help clinicians determine the diagnosis of IE. Systemic embolization could cause many complications that may present as chief complaint underlying patient hospitalization. CASE PRESENTATION: We present case series of diverse manifestation of IE in children in Bandung, West Java, Indonesia. Two cases had a history of structural heart disease, while one case with no history of any structural heart disease before. CONCLUSION: Wide range of symptoms that could occur in children with IE, made it challenging to make a proper diagnosis.

儿童感染性心内膜炎的诊疗进展

儿童感染性心内膜炎的诊疗进展

Wegetacje na zastawce dwudzielnej u 16-letniej dziewczynki leczonej chirurgicznie metodą małoinwazyjnej rekonstrukcji

Infective endocarditis in children is a rare complication and is most often associated with dental interventions. It may develop in course of congenital and acquired heart defects, as well as previous cardiac surgeries. The case regards a 16-year-old girl reporting significant fatigue, low-grade fever, lack of appetite with a weight loss of 5 kg, apathy, and enlargement of the spleen over six months before admission. Physical examination exposed systolic murmur in the apical region. The patient was admitted to a general paediatric ward and then, after confirming vegetation on the mitral valve, further treatment was carried out in the paediatric cardiology ward. The blood cultures revealed Streptococcus Gordoni infection. Intensive antibiotic treatment was initiated under the control of blood cultures, which were negative after 7 days of treatment. An interdisciplinary council meeting decided to continue the treatment. Cardiosurgical consult resulted in transferring the patient to the adult cardiosurgery ward, even though she was not of age, where a minimally invasive valve reconstruction was performed using artificial tendon threads and an artificial Carpentier–McCarthy–Adams 26 mm mitral ring. The postoperative course was uneventful and the girl was returned to the care of paediatric cardiologists. Currently, she is in good condition and is under constant control.

Value of Time-Resolved Cardiac CT in Children and Young Adults with Congenital Heart Disease and Infective Endocarditis.

Diagnosis of infective endocarditis (IE) can be challenging due to negative blood cultures and diagnostic limitations of various imaging modalities. Transesophageal echocardiography (TEE) is the gold standard imaging modality for visualization of valvular vegetations. However, due to the anterior location of the pulmonary valve, post-surgical changes, and sedation requirement, TEE can be challenging in the pediatric population. The aim of this study was to assess the value of Cardiac CT (CCT) for diagnosis of IE in children and young adults with congenital heart disease (CHD). This is a single-center retrospective study of pediatric patients with CHD and diagnosis of IE who underwent CCT from 2018 to 2022. Data collected included age, gender, cardiac diagnosis, clinical presentation, echocardiographic/CCT findings, and blood culture results. In addition, modified Duke criteria (MDC) for the diagnosis of IE were applied with and without CCT findings as the diagnostic imaging criterion. Fourteen patients were included in this study with a median age of 11years old. Nine patients were female. Ten patients had IE of the RV-PA conduit and four patients had IE of the aortic valve. Using MDC, 4 patients had definite IE. After including CCT findings, 11 patients (79%) met MDC for definite IE. Blood cultures were positive in 12 patients. CCT revealed the following complications: thromboembolic findings/pseudoaneurysms in 5 patients each and prosthetic valve perforation/prosthetic valve leak in one patient each. This study reinforces the complimentary role of CCT to echocardiography in the work-up and diagnosis of IE in patients with CHD. With further improvement in lowering radiation exposure, CCT may have a key role in the diagnostic work-up of endocarditis and could be implemented in the diagnostic criteria of IE.

Oral hygiene and gingival disease among children with structural heart disease at a tertiary hospital in North-Central Nigeria

Background: Poor oral hygiene and gingival disease are factors that increase risk of infective endocarditis in children with structural heart disease. The objectives were to evaluate the oral hygiene status of children with structural heart disease and the prevalence of dental caries/ gingival disease among them.
 Methods: Descriptive, cross-sectional study. Subjects were children aged6 months to 14 years with structural heart disease. Relevant sociodemographic and clinical data were collected. The Decayed, Missing Filled –Teeth (DMF-T) index and Simplified Oral Hygiene index-S (OHI-S) were used to evaluate for dental caries and oral hygiene respectively.
 Results: Forty-eight subjects were recruited. Median (IQR) age was 1.88 (0.50 – 6.75) years. Commonest structural heart diseases were ventricular septal defects (19 subjects; 39.6%), rheumatic heart disease (6; 12.5%), and Tetralogy of Fallot (5; 10.4%). Prevalence of dental caries amongst subjects was 11.4% (four of the 35). Six (12.5%) had gingival disease and one (2.9%) had poor oral hygiene. Thirty-two (91.4%) subjects had their mouth cleaned daily, while only four (12.5%) of these had it cleaned at least twice a day.
 Conclusion: Dental caries and poor oral hygiene are common amongst children with structural heart disease.

The Incidence and Clinical Characteristics of Infective Endocarditis in Children: A Five-Year, Single-Centre Retrospective Evaluation.

Infective endocarditis (IE) is a rare disease with high mortality and morbidity. In recent years, an increase in the frequency of infective endocarditis has been observed due to the increase in the survival of cases with congenital heart diseases (CHDs) and the use of central catheters. In addition to revealing the incidence of IE in our clinic, this study aimed to evaluate the demographic characteristics, predisposing factors, clinical, laboratory, microbiological, and echocardiographic findings, and the complications of follow-up of our patients diagnosed with IE in light of the literature. Thirteen patients with IE who were hospitalized in Pediatric Cardiology Clinic, Pamukkale UniversityMedical Faculty Hospital between January 2016 and August 2021 were retrospectively reviewed. The patients included in the study were evaluated in terms of demographic characteristics, predisposing factors, clinical, laboratoryand microbiological findings, echocardiography data, surgical intervention needs, and complications. The incidence of IE in our clinic was defined as the rate of IE among patients admitted to the hospital and reported as the number of patients with IE per 100,000 hospital admissions. The median age of these 13 patients was 11 (7-14) years, and the male/female ratio was 6/7. The five-year IE incidence in Pediatric Cardiology Clinic, Pamukkale UniversityMedical Faculty Hospital, was found to be 2.5 in approximately 100,000 hospital admissions. A predisposing factor was detected in all patients. Six patients (46%) had CHDs, and four patients (31%) had acquired heart disease. The other three (23%) patients were receiving immunosuppressive therapy, and these patients had long-term port catheters.Eight (62%) patients had positive blood cultures.Streptococcusviridans, Streptococcus gordonii, Staphylococcus aureus, coagulase-negativeStaphylococcus, Brucella spp, and Candida albicans were isolated in the blood cultures of these patients. IE-related complications developed in seven (54%) patients. Five (38%) had heart failure, three patients (23%) had thromboembolic events, two (15%) had glomerulonephritis, and one (8%) had thrombophlebitis. Four patients were referred to early surgery. Two patients with recurrent IE attacks were referred to surgery after their treatment was completed. The incidence of IE has shown an increase recently with increased rates of survival attributable to corrective surgeries performed for congenital heart diseases, increased prosthetic materials used in cardiac surgeries, and increased use of permanent catheters. In our study, theincidence of IE was found to be 2.5 in 100,000 hospital admissions. Our results have shown that rheumatic heart diseases, besides CHDs, are still an important risk factor for Turkey. Due to the low number of cases in IE studies in the pediatric population, there is a need for further studies to be conducted in large series in this field.

Infectious Endocarditis in Children: Epidemiological, Clinical, Paraclinical and Therapeutic Profile

Introduction: Infective endocarditis (IE) in children is a serious pathology with high mortality and morbidity. The aim of our study was to describe the clinical, microbiological, therapeutic and evolutionary characteristics of infective endocarditis in children. Materials and methods: This is a retrospective study, listing all children aged less than 15 years, diagnosed in pediatric cardio consultation and hospitalized in the department of Pediatrics A-Mother and Child Hospital of Marrakech for infective endocarditis between 2010 and 2020. Clinical, paraclinical and therapeutic data were collected for each case using an exploitation form. Results: During the study period, 25 children presented with infective endocarditis, with a sex ratio equal to 1.08. The mean age of the patients was 9 years and 6 months. Underlying heart disease was found in 76% of cases. A cardiac murmur was noted in 96% of cases, and the most frequent germs were Staphylococcus and Streptococcus. Cardiac ultrasound revealed endocardial vegetations in 72% of the children. Intravenous antibiotic therapy was initiated in all children for a median of 45 days, and an indication for valve replacement was given in 16% of cases. According to the modified Duke criteria, 28% of the infective endocarditis cases were definite and the evolution was favorable in 80% of the children. The most frequent complications were valve failure, heart failure, and embolic complications, and death in 5 cases. Conclusion: The analytical study concluded that embolic complications, heart failure and neurological complications are predictive of mortality. Therefore, its management must be multidisciplinary, early and adequate.

Pediatric Infective Endocarditis: A Literature Review.

Infective endocarditis in children is a rare entity that poses multiple challenges. A history of congenital heart disease is the most common risk factor, although in recent years, other emerging predisposing conditions have gained relevance, such as central venous catheters carriers or children with chronic debilitating conditions; cases in previously healthy children with no medical history are also seen. Diagnosis is complex, although it has improved with the use of multimodal imaging techniques. Antibiotic treatment should be started early, according to causative microorganism and risk factors. Complications are frequent and continue to cause significant morbidity. Most studies have been conducted in adults and have been generalized to the pediatric population, with subsequent limitations. Our manuscript presents a comprehensive review of pediatric infective endocarditis, including recent advances in diagnosis and management.

Neurologic complications of infective endocarditis in children.

To define the frequency and characteristics of acute neurologic complications in children hospitalised with infective endocarditis and to identify risk factors for neurologic complications. Retrospective cohort study of children aged 0-18years hospitalised at a tertiary children's hospital from 1 January, 2008 to 31 December, 2017 with infective endocarditis. Sixty-eight children met Duke criteria for infective endocarditis (43 definite and 25 possible). Twenty-three (34%) had identified neurologic complications, including intracranial haemorrhage (25%, 17/68) and ischaemic stroke (25%, 17/68). Neurologic symptoms began a median of 4.5days after infective endocarditis symptom onset (interquartile range 1, 25days), though five children were asymptomatic and diagnosed on screening neuroimaging only. Overall, only 56% (38/68) underwent neuroimaging during acute hospitalisation, so additional asymptomatic neurologic complications may have been missed. Children with identified neurologic complications compared to those without were older (48 versus 22% ≥ 13years old, p = 0.031), more often had definite rather than possible infective endocarditis (96 versus 47%, p < 0.001), mobile vegetations >10mm (30 versus 11%, p = 0.048), and vegetations with the potential for systemic embolisation (65 versus 29%, p = 0.004). Six children died (9%), all of whom had neurologic complications. Neurologic complications of infective endocarditis were common (34%) and associated with mortality. The true frequency of neurologic complications was likely higher because asymptomatic cases may have been missed without screening neuroimaging. Moving forward, we advocate that all children with infective endocarditis have neurologic consultation, examination, and screening neuroimaging. Additional prospective studies are needed to determine whether early identification of neurologic abnormalities may direct management and ultimately reduce neurologic morbidity and overall mortality.

Infective Endocarditis in Children with Isolated VSD: A Single Center Study

Aim: To determine the characteristics of isolated ventricular septal defect (VSD) in association with infective endocarditis (IE) among children with isolated VSD and its outcome. Method: This was cross-sectional study. Data was collected prospectively from infective endocarditis patients with isolated ventricular septal defect (VSD), admitted in pediatric cardiology ward of The Children’s hospital and Institute of Child Health, Lahore. Study period was from September 2018 till March 2021. The data was analyzed by using SPSS-26. Result: Sixty patients of ventricular septal defect (VSD) with infective endocarditis (IE), fulfilling the inclusion criteria, were included in the current study. Mostly about 60% were male. Transthoracic Echocardiography was done for all the patients. Single vegetation was found among 68.3%, rest were having multiple vegetations. seen. Approximately 57% were having small size vegetations while remaining 43% were with moderated – large vegetations. Complications were reported in only 18% of the study population. Regarding outcome majority of the patients (90%) were successfully treated with medical management alone, while only 8.3% required surgical intervention as well. Only 1 out of 60 patients included in the study was expired. Characteristic of VSD, size of vegetation, and number of vegetations have significant influence on development of complications (p = &lt;0.05). Conclusion: Risk of complications among infective endocarditis with isolated VSD is comparatively greater with large vegetation and multiple number of vegetations as compared to single or small vegetation. Medical management is main stay of treatment while surgical intervention is usually required among infective endocarditis patients with DCSA-VSD &amp; subaortic-VSD. Key words: Ventricular septal defect (VSD), DCSA (doubly committed sub-arterial) VSD, Infective endocarditis (IE).

Etiological Factors of Infective Endocarditis in Children Aged 1 Month to 15 Years Hospitalised in the Paediatric Department of CHU Gabriel Tour&amp;#233; of Bamako (Mali)

Introduction: In emerging countries where studies are rarer, the epidemiological profile of infective endocarditis resembles that of developed countries at the beginning of the antibiotic era. There is little data available in Mali on this subject, motivating this study, the aim of which was to study the etiological factors of infective endocarditis in children aged between 1 month and 15 years hospitalised in the paediatric department of the CHU Gabriel Touré. Patients and Methods: We conducted a cross-sectional and descriptive study, which took place from August 2018 to August 2019 (13 months), in children aged between 1 month and 15 years hospitalised in the paediatric department of the Gabriel Touré University Hospital with an ultrasound- confirmed cardiac disease and a temperature above 38°C. Results: The hospitalization rate was 0.4%. The average age was 11 months, the sex ratio was 1.35. Respiratory distress (63.6%) and fever (30.3%) were the most common reasons for referral. Congenital heart disease (87.9%) and dyspnoea on feeding (24.2%) were the most common medical histories. IVC was the most frequent congenital heart disease (36.4%). The mean temperature was 39.1°C. Blood cultures were taken in 24 patients (72.7%) and were positive in 27.3%. Staphylococcus aureus was found in 55.6% of cases. Trans-thoracic ultrasound found vegetations in 03 cases. According to the modified DUKE criteria, the diagnosis of endocarditis was retained in 27.30%. The evolution was marked by a high case fatality rate (45.45%). Conclusion: Endocarditis is an uncommon disease in children with a pulmonary portal of entry and Staphylococcus aureus as the main germ. Its mortality remains high.

Epidemiology of infective endocarditis in Africa: a systematic review and meta-analysis

The epidemiology of infective endocarditis in Africa is inadequately characterised. We therefore aimed to comprehensively summarise the available data for the incidence, risk factors, clinical pattern, microbiology, and outcomes of infective endocarditis in Africa. We did a systematic review and meta-analysis. We searched PubMed, Embase, African Index Medicus, and African Journals Online for all studies reporting primary data for the epidemiology of infective endocarditis in populations within Africa, published from inception to Jan 14, 2021, irrespective of the language. We used the search terms "endocarditis", "Africa", and the name of all African countries in the search strategy. We excluded articles that did not include primary data, primary studies with a small sample size (<30 participants), and those that report findings from before 1990. We recorded data for study characteristics, sample size, criteria used to define infective endocarditis, risk factors, potential entry site, clinical patterns, microbiology profile, outcomes including complications such as embolic events, heart failure, acute kidney injury, and death, and predictors of death. We used random-effects meta-analysis method to pool estimates. This study is registered with PROSPERO, CRD42021243842. We retrieved 2141 records from the database and bibliographic searches, of which a total of 42 studies were included in this systematic review. Rheumatic heart disease was the most common risk factor for infective endocarditis in adults (52·0% [95% CI 42·4-61·5]), whereas congenital heart disease was the most common risk factor for infective endocarditis in children (44·7% [29·5-60·5]). Microbiological testing (mostly blood cultures) was positive in 48·6% (95% CI 42·2-51·1) of patients with infective endocarditis, with Staphylococcus species (41·3% [95% CI 36·2-46·5]) and Streptococcus species (34·0% [29·0-39·3]) the most commonly identified microorganisms. The pooled rate of surgical treatment of infective endocarditis was 49·1% (95% CI 43·2-55·1). The pooled in-hospital mortality rate was 22·6% (95% CI 19·5-25·9). Other frequent complications included heart failure (47·0% [95% CI 38·2-56·0]), acute kidney injury (22·8% [18·8-27·0]), and embolic events (31·1% [22·2-40·7]). As the most prevalent risk factor in Africa, rheumatic heart disease should be central in interventions to reduce the burden of infective endocarditis on the continent. In tertiary hospitals with good access to cardiac surgery, the outcomes of infective endocarditis seem relatively similar to what has been reported in other parts of the world, especially in high-income countries. None.