Bacterial endocarditis in childhood

Background Bacterial endocarditis in childhood is a rare but serious disease. The group of children with congenital heart disease at risk to develop bacterial endocarditis increases, because more children survive with advanced medical and surgical managment. Rheumatic Fever as predisposing heart disease decreases and is of reduced importance. Patients From 1983 to 1993 16 patients in the age of 0.3 to 17.6 years (mean 10.6 years) were received by the Department of Pediatric Cardiology of the University Children's Hospital Vienna with the diagnosis ''bacterial endocarditis''. A congenital heart disease was known previously in 13 cases: 4 children had VSD, 2 children had Tetralogy of Fallot, 1 child had a single ventricle and an infundibular pulmonary stenosis, 4 children had pulmonary atresia, 1 child had a cleft of the mitral valve, and 1 child had a coronary artery fistula. Moreover, 1 child had a mitral valve prolapse with valvular regurgitation as a consequence of Marfan-Syndrome. 6 children with congenital heart disease had been treated surgically previously. Methods Medical data of all patients with the diagnosis of ''bacterial endocarditis'' between 1983 and 1993 were analysed. It was this period when echocardiography was used for the first time to contribute to diagnosis and course control. Results in 11 of 16 cases positive blood cultures were obtained. Mostly Streptococcus viridans (4 cases) and Staphylococcus aureus (3 cases) were isolated. During the parenteral therapy with antibiotics 9 children suffered as a side effect from a drug induced fever and/or decreasing leucocytes and thrombocytes or a rash. In addition to the antibiotic therapy 8 children were treated surgically. One child died immediately after the operation. 15 of the 16 patients with endocarditis survived. Conclusions With children with known heart disease the recommendations for the prevention of bacterial endocarditis have to be strictly followed and every long ongoing feverish disease has to be carefully examinated.