Abstract :
Background: The second half of the 2Qth century has witnessed major changes in the epidemiology, bacteriology and clinical presentation of infective endocarditis (IE). Aim of Work: To evaluate local patient characteristics, risk factors, clinical sequelae, microbiology, morbidity and mortality in paediatric patients with IE and to explore the use of trans-thoracic echocardiography (TTE) in the diagnosis of this illness. Methods: Thirty patiehts with probable or definite diagnosis of IE were prospectively enrolled in this study. Infective endocarditis was diagnosed according to the Duke criteria. Patients with rejected diagnosis of IE were excluded. Underlying risk factors were sought. Initial evaluation and inhospital follow-up included the documentation of vascular or immunological phenomena, morbidity and mortality. Results: Of the 30 patients included, 24 cases (80%) had definite IE and 6 cases (20%) had possible IE. The studied patients had a mean age of 7.2±3.9 years with a male predominance (1.5:1). Rheumatic heart disease was present in 14 (46.7%), two of them had prosthetic valves (PVE). Fifteen had congenital heart disease (50%), one patient (3.3%) with no underlying cardiac lesion. Congestive heart failure and fever were detected in 100%, Glomerulonephritis without renal failure was observed in 2 patients (6.7% ), embolic events in 8 cases (26.7%). Blood culture was positive in 27 cases (90%), with staph. aureus the most common isolates. TTE was definitive for vegetation. in 25 cases (83.3% ), possible in 4 cases including the two cases of PV and negative in one case. TEE required for the 2 PVE cases. The in-hospital mortality rate (medical and surgical) was 13.3%. Conclusion: The clinical features of the present study almost have a similar pattern as the earlier studies. Increasing staph. aureus IE. The in-hospital morbidity and mortality are high. TTE remains the most appropriate first-line imaging investigation in the paediatric age group. TEE is indicated when the clinical suspicion of endocarditis is high and the TTE study is inconclusive.
