2. Infective Endocarditis (IE)
o An acute or subacute inflammation of the
endocardium caused by bacteria, virus or fungi
o Common etiologic are:
Streptococcus Viridans
Staphylococcus Aureus
Group D Streptococcus
3. Infective …
•Pathophysiology
o Most often a complication of congenital or
Rheumatic heart disease
o But can occur with out any residual cardiac
defects
o Rheumatic heart disease, primarily mitral and
aortic valves, common in our setup
4. Infective …
o Preceding dental, urinary or intestinal
procedures identified in one third of patients
as a source of infection
o Other risks are central venous catheterization,
prosthetic valves etc…
o Vegetation found at the site of endocardial
erosion that result from high velocity blood
flow
5. Infective …
o Thus children with VSD, PDA and left sided
valvular lesions are at high risk of ID
•Clinical manifestations
o Onset can be acute and severe with:
High grade fever and prostration, or
o Insidious
With prolonged fever
o Commonly it varies within a range between the
two
6. Infective …
•Common symptoms are:
o Low grade fever, chills, fatigue, arthralgia,
myalgia, malaise, night sweats, weight loss,
stroke or seizure
•Physical findings:
o Tachycardia, arrhythmia
o New or changing murmur
o Splenomegaly
7. Infective …
o Arthritis
o Heart failure
o Neurologic deficits
o Skin manifestations such as:
Petechia, splinter hemorrhage (nail bed bleeding)
Janeway lesions (painless small hemorrhagic lesions
on palms and soles)
Osler nodes (tender pea sized intradermal nodules
in the pads of fingers)
o Clubbing
8. Infective …
•Lab Findings
o Blood culture
3-5 separate samples, positive in 90% of cases
without prior antibiotic intake
o Additional information can be obtained from:
Echocardiography (vegetations), raised ESR,
leucocytosis, anemia, hematuria, renal failure….
•Diagnosis
o Gold standard is blood culture
9. Infective…
•Treatment
o Hospitalization
o Specific
Initial empiric antibiotics to cover Gram positive
and negative organisms.
Combination of cloxaxillin, ampicillin and
gentamycin for 4-6 weeks (except gentamycin for
2 weeks)
o Supportive
For heart failure and nutrition
10. infective…
•Prevention
o General dental care and oral hygiene
o Treatment of infection in high risk children
o Antibiotic prophylaxis before
surgical procedures of genito-urinary and gastro-
intestinal systems
