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We review the predisposing conditions, the presenting signs and symptoms, as well as the risk factors and bacterial etiologies
in children with infective endocarditis, focusing on hospital course and outcome. We conducted a retrospective analysis of
76 cases of endocarditis in 73 patients occurring at Children's Hospital of Pittsburgh from January...
Similar publications
Background and Objectives: The development of new antibiotics and the advances in cardiac surgery has increased the number of patients with congenital heart disease (CHD) who grow into adulthood, and infective endocarditis (IE) has become one of the important complications. The aim of this study was to analyze the clinical findings of IE that occur...
Infective endocarditis is a rare disease in children, and it can result in significant morbidity and mortality. The epidemiology of infective endocarditis in children has shifted in recent years with less rheumatic heart disease, more congenital heart disease survival, and increased use of central venous catheters in children with chronic illness....
Background: The spectrum of infective endocarditis (IE) is significantly different in developed and developing countries. The present study was conducted to study the clinical profile and outcome of infective endocarditis in Pakistan. Methods: A descriptive cross-sectional study with review of medical records for 188 patients admitted to our teachi...
Citations
... Инъекционная наркомания, в ряде случаев отмечающаяся в подростковой популяции, а также медицинские процедуры, обуславливаю-щие нарушение целостности сосудистой стенки, предрасполагают к возникновению ассоциированной с S.aureus бактериемии [11]. ...
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.
... Bacterial pathogens become entangled in fibrin and platelets to form vegetations that can damage heart valves or endocardial tissue. The incidence of endocarditis in adults is 3 to 7 per frequently associated with rheumatic heart disease, unrepaired cardiac defects, and late postoperative endocarditis [7][8][9]. Staphylococcus aureus can cause endocarditis in normal hearts. Coagulase negative Staphylococcus is associated with cardiac surgery and its incidence is increasing. ...
... This occurs most frequently due to current or prior treatment with antibiotics. However, other causes include infections due to slow growing or atypical organisms, and inadequate microbiological techniques [4,8,12]. In our study patients the rate of negative blood cultures was 11.8%. ...
Background:
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.
Methods:
Retrospective review of IE cases during 2002-2020 at Children's Hospital of Michigan, Detroit.
Results:
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.
Conclusion(s):
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.
... Papillary renal cell carcinoma with clear cytoplasmic changes usually contains other typical ancillary features of papillary renal cell carcinoma, such as foamy macrophages or psammoma bodies, and a helpful clue is that the cytoplasm is often highly vacuolated rather than empty-appearing. In contrast to clear cell papillary renal cell carcinoma, papillary renal cell carcinoma is consistently strongly positive for AMACR, and carbonic anhydrase IX usually shows minimal labeling, sometimes associated with areas of ischemia or necrosis [3,6,8,12,15,16,17] . MITF family translocationassociated renal cell carcinoma. ...
... Martin et al identified valvular insufficiency as the most common complication in a group of 76 children from 1954 to 1992. Complications occurred more often in patients who had positive blood cultures for S. aureus than in those where Streptococcus viridans were found to be the causative agent [ 15] . Daumy congestive heart failure, followed by lung embolisms (21.8%), cerebral embolisms, and pneumonia (10.9%) [16] . ...
Abstract
Background: Cases of a foreign body within the rectum are rarely reported in Albania, an Southeastern
Europe country. The etiology of the benefit of sexual pleasure for foreign bodies inserted into the rectum
can be as much as 75% of the cases.
Presentation of the case: A 38-year-old white man came to the Emergency Department at University
Trauma Hospital, Tirana, Albania. The patient had used a screwdriver as a masturbation tool and reported
severe pain and pelvic discomfort for the last two days, as he repeatedly attempted to remove the screwdriver
from the rectum, but to no avail. After general anesthesia, the surgical staff used Kelly Forceps with the pa-
tient in the Kraske position to remove the screwdriver from the rectum. There have been no complications
such as pneumoperitoneum or obstruction, only superficial mucosal lacerations. The patient was discharged
from the hospital in 2 days.
Discussion: The algorithm for the treatment of foreign bodies within the rectum varies from manual removal
without anesthesia for very low-lying objects, to manual removal with anesthesia (to relax the anal sphincter)
for high-lying foreign bodies and open surgery (laparotomy) for patients with complications such as peri-
tonitis or perforation.
Conclusion: Rectal sexual injuries due to a foreign body inserted in the rectum, are also increasing in coun-
tries like Albania, a post-communist country in South-Eastern Europe. Management without an open surgical
procedure, but only removal of the foreign body under anesthesia, should always be considered in cases
without complications.
Keywords: Anorectal trauma, foreign body, sexual gratification
... Ventricular septal defect (VSD), patent ductus arteriosus (PDA), aorta or aortic arch anomalies, and tetralogy of Fallot are common underlying conditions. An increasing proportion of corrective or palliative surgeries for CHD, with or without implanted patches, vascular grafts, or prosthetic cardiac valves, also contribute to IE incidence [3,4]. However, the clinical characteristics and outcomes of pediatric patients with IE and the differences in those with and without heart disease suffering from IE are limited. ...
... Patients with IE have a broad spectrum of complications. Cardiac complications were the principal cause of morbidity, and neurological or embolic complications were significantly fewer in our study than in the previous studies [3,28]. The highly variable clinical presentation of IE may reflect the variable causative microorganisms and underlying cardiac conditions. ...
... However, Staphylococcus distribution was less in patients with HD [30,31]. S. aureus in IE has a higher rate of complications, particularly neurological complications, and mortality when compared with other pathogens [3,32]. Although patients with underlying HD are known to have a worse prognosis [31], our decreased morbidity and mortality rate might be partially due to the lower percentage of S. aureus as the underlying pathogen. ...
Background:
Infective endocarditis (IE) is an important cause of morbidity and mortality in pediatric patients with heart disease. Little literature has explored differences in the presentation of endocarditis in children with and without heart disease. This study aimed to compare the clinical outcomes and determine the risk of in-hospital death in the study population.
Methods:
Data were retrospectively collected from 2001 to 2019 from the Chang Gung Research Database (CGRD), which is the largest collection of multi-institutional electronic medical records in Taiwan. Children aged 0-20 years with IE were enrolled. We extracted and analyzed the demographic and clinical features, complications, microbiological information, and outcomes of each patient.
Results:
Of the 208 patients with IE, 114 had heart disease and 94 did not. Compared to those without heart disease, more streptococcal infections (19.3% vs. 2.1%, p < 0.001) and cardiac complications (29.8% vs. 6.4%, p < 0.001) were observed in patients with heart disease. Although patients with heart disease underwent valve surgery more frequently (43.9% vs. 8.5%, p < 0.001) and had longer hospital stays (28.5 vs. 12.5, p = 0.021), their mortality was lower than that of those without heart disease (3.5% vs. 10.6%, p = 0.041). Thrombocytopenia was independent risk factor for in-hospital mortality in pediatric patients with IE (OR = 6.56, 95% CI: 1.43-40.37).
Conclusion:
Among pediatric patients diagnosed with IE, microbiological and clinical features differed between those with and without heart disease. Platelet counts can be used as a risk factor for in-hospital mortality in pediatric patients with IE.
... From our analytical study, we retained that the occurrence of embolic and/or hemodynamic and/or neurological complications are predictive factors of mortality during IE. The most common prognostic factors are comorbid cardiac conditions, type of microorganism involved (staphylococcus aureus and fungal infections) [26], location (left heart), increase in the size of the vegetations, acute nature of the onset of endocarditis, and complications (heart failure, renal failure, neurological involvement, or rhythmic and conduction disorders). In the most recent studies in developed countries, mortality has decreased: 4-7% in recent American studies [22,27] and 6% in a recent Italian registry [28]. ...
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.
... In adults, degenerative valve disease and intravenous drug abuse are relevant risk factors for IE, although they are rare in children [16]. In adults without previous heart disease, chronic kidney disease on hemodialysis is a common risk factor for IE [17]. ...
... However, 5 to 7% of patients with IE have negative blood cultures [6,39,40]. In these cases, previous treatment with antibiotics, infections by slow-growing germs, or inadequate microbiological techniques may explain the absence of the identification of the pathogen [16,20,37]. In a very low proportion of cases, it could be a non-infectious endocarditis, in the context of autoimmune processes such as lupus, although this situation is very rare in children. ...
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.
... In the literature, patients with comorbidities other than obesity and malnutrition at risk of complications during surgery are cardiopathic subjects, whether or not they have undergone previous operations. The available studies have been mainly addressed to consider the risk of developing endocarditis more than other infectious pathologies falling within SSI [40,41]. From the evaluation of several studies, it was concluded that patients with valve prostheses or prosthetic material used for valve repair; those who have already suffered from bacterial endocarditis; those with cyanogenic congenital heart disease (both not surgically corrected and corrected with the use of prostheses in the 6 months following the operation); and, finally, those undergoing heart transplantation who have developed valvulopathy are at greater risk of developing bacteremia and endocarditis [42]. ...
Surgical site infections (SSIs), which are a potential complications in surgical procedures, are associated with prolonged hospital stays and increased postoperative mortality rates, and they also have a significant economic impact on health systems. Data in literature regarding risk factors for SSIs in pediatric age are scarce, with consequent difficulties in the management of SSI prophylaxis and with antibiotic prescribing attitudes in the various surgical procedures that often tend to follow individual opinions. The lack of pediatric studies is even more evident when we consider surgeries performed in subjects with underlying conditions that may pose an increased risk of complications. In order to respond to this shortcoming, we developed a consensus document to define optimal surgical antimicrobial prophylaxis (SAP) in neonates and children with specific high-risk conditions. These included the following: (1) colonization by methicillin-resistant Staphylococcus aureus (MRSA) and by multidrug resistant (MDR) bacteria other than MRSA; (2) allergy to first-line antibiotics; (3) immunosuppression; (4) splenectomy; (5) comorbidity; (6) ongoing antibiotic therapy or prophylaxis; (7) coexisting infection at another site; (8) previous surgery in the last month; and (9) presurgery hospitalization lasting more than 2 weeks. This work, made possible by the multidisciplinary contribution of experts belonging to the most important Italian scientific societies, represents, in our opinion, the most up-to-date and comprehensive collection of recommendations relating to behaviors to be undertaken in a perioperative site in the presence of specific categories of patients at high-risk of complications during surgery. The application of uniform and shared protocols in these high-risk categories will improve surgical practice with a reduction in SSIs and consequent rationalization of resources and costs, as well as being able to limit the phenomenon of antimicrobial resistance.
... 3 IE is uncommon in children, 4 although due to the progressive greater survival of children with congenital heart disease (CHD), its frequency is increasing. [5][6][7] Most previous studies that analyze the peculiarities of pediatric IE do not compare their clinical profile and evolution with adult IE. [8][9][10][11][12][13] In addition, there have been recent changes in the antibiotic prophylaxis recommendations for IE. 14 Children/ adolescents and adults have differences in comorbidities and predisposing factors for IE that could lead to differences in etiology, diagnosis, and prognosis. ...
Background:
Our aim was to compare pediatric infective endocarditis (IE) with the clinical profile and outcomes of IE in adults.
Methods:
Prospective multicenter registry in 31 Spanish hospitals including all patients with a diagnosis of IE from 2008 to 2020.
Results:
A total of 5590 patients were included, 49 were <18 years (0.1%). Congenital heart disease (CHD) was present in 31 children and adolescents (63.2%). Right-sided location was more common in children/adolescents than in adults (46.9% vs. 6.3%, P < 0.001). Pediatric pulmonary IE was more frequent in patients with CHD (48.4%) than in those without (5.6%), P = 0.004. Staphylococcus aureus etiology tended to be more common in pediatric patients (32.7%) than in adults (22.3%), P = 0.082. Heart failure was less common in pediatric patients than in adults, due to the lower rate of heart failure in children/adolescents with CHD (9.6%) with respect to those without CHD (44.4%), P = 0.005. Inhospital mortality was high in both children, and adolescents and adults (16.3% vs. 25.9%; P = 0.126).
Conclusions:
Most IE cases in children and adolescents are seen in patients with CHD that have a more common right-sided location and a lower prevalence of heart failure than patients without CHD. IE in children and adolescents without CHD has a more similar profile to IE in adults.
Impact:
Infective endocarditis (IE) in children and adolescents is often seen in patients with congenital heart disease (CHD). Right-sided location is the most common in patients with CHD and heart failure is less common as a complication compared with patients without CHD. Infective endocarditis (IE) in children/adolescents without CHD has a more similar profile to IE in adults. In children/adolescents without CHD, locations were similar to adults, including a predominance of left-sided IE. Acute heart failure was the most frequent complication, seen mainly in adults, and in children/adolescents without CHD.
... Unlike adults, majority (75%-80%) of children with IE have underlying heart disease. [1] While 10%-15% of children have other risk factors, approximately 8%-10% of patients have no risk factor for IE. [1] The data on right-sided IE are further limited, but it is uncommon in the absence of structural abnormality of the heart and/or risk factors such as indwelling central venous catheter. ...
... [1] While 10%-15% of children have other risk factors, approximately 8%-10% of patients have no risk factor for IE. [1] The data on right-sided IE are further limited, but it is uncommon in the absence of structural abnormality of the heart and/or risk factors such as indwelling central venous catheter. [2] IE of the tricuspid valve usually presents with vegetation with or without manifestations of embolization of vegetation to the lungs. ...
... Electrocardiogram [ Figure 1] confirmed CHB with an atrial rate of 148 beats/min and ventricular rate of 42 beats/min with complete right bundle branch block (QRS duration -110 ms). Transthoracic echocardiography revealed two large vegetations, with one measuring 14 mm × 10 mm attached to the septal tricuspid leaflet and the other measuring 10 mm × 6 mm attached to anterior tricuspid Infective endocarditis-induced complete closure of a ventricular septal defect and complete heart block in a child Umadevi Karuru 1 , Jay Relan 1 , Shyam S. Kothari 1 , Saurabh Kumar Gupta 1 ...
We hereby report rare occurrence of irreversible complete heart block in a child with tricuspid valve infective endocarditis. The tricuspid valve vegetation also caused complete closure of perimembranous ventricular septal defect, which was later discovered during surgery.
... RHD was a risk factor in a small proportion of our patients (6.4%), possibly because our center is a reference center for CHD. In the literature, pediatric patients diagnosed with IE are accompanied by CHD with a range of 41.7%-81% [4,5,[10][11][12][13][14] . In many studies, the risk of IE in CHDs was found to be higher in the left heart structures [15][16][17] . ...
... In a study by Rosenthal et al. [3] , the predisposing factor was identified as heart disease in 72% of patients with IE. In the literature, the incidence of IE in CHD has been reported to be 35%-51% in children with complex, cyanotic CHD [5,12,13] . In our study, the incidence of CHD was as high as 85% probably because children with CHD are monitored more intensively at our center. ...
... The most common symptoms of IE are fever and weight loss [13] . In our study, fever was the most common symptom followed by weight loss. ...
Introduction:
We aimed to present the risk factors, clinical and laboratory findings, treatment management, and risk factors for morbidity and mortality of infective endocarditis (IE) as well as to relate experiences at our center.
Method:
We retrospectively analyzed data of 47 episodes in 45 patients diagnosed with definite/possible IE according to the modified Duke criteria between May 2000 and March 2018.
Results:
The mean age of all patients at the time of diagnosis was 7.6±4.7 years (range: 2.4 months to 16 years). The most common symptoms and findings were fever (89.3%), leukocytosis (80.8%), splenomegaly (70.2%), and a new heart murmur or changing of pre-existing murmur (68%). Streptococcus viridans (19.1%), Staphylococcus aureus (14.8%), and coagulase-negative Staphylococci (10.6%) were the most commonly isolated agents. IE-related complications developed in 27.6% of the patients and the mortality rate was 14.8%.
Conclusion:
We found that congenital heart disease remains a significant risk factor for IE. The highest risk groups included operated patients who had conduits in the pulmonary position and unoperated patients with a large ventricular septal defect. Surgical intervention was required in most of the patients. Mortality rate was high, especially in patients infected with S. aureus, although the time between the onset of the first symptom and diagnosis was short. Patients with fever and a high risk of IE should be carefully examined for IE, and evaluation in favor of IE until proven otherwise will be more accurate. In high-risk patients with prolonged fever, IE should be considered in the differential diagnosis.
