infective endocarditis

infective endocarditis

1. risk of IE

   • in kids of any age w/ congenital heart disease
     • except those w/ secundum ASD
   • risk highest where there is turbulent jet of blood
     • VSD
     • coarctation of aorta
     • persistent ductus arteriosus
     • surgical insertion of prosthetic stuff

2. be highly suspicious!

   • any child/adult w/
     • sustained fever
     • malaise
     • raised ESR
     • unexplained anaemia
     • haematuria
   • don't rely on presence of classical physical stigmata for diag

3. clinical signs

   • fever
   • anaemia & pallor
   • splinter haemorrhages in nailbed
   • clubbing (late)
   • necrotic skin lesions
   • changing cardiac signs
   • splenomegaly
   • neuro signs from cerebral infarction
   • retinal infarcts
   • arthritis/arthralgia
   • haematuria (microscopic)

4. diagnosis

   • multiple blood cultures should be taken
     • before Abx started
   • detailed cross sec echo
     • confirm diag by IDing vegetations
       • but can never exclude IE
       • vegetations made of fibrin & platelets
         • contain pathogen
   • raised acute phase reactants
     • useful to monitor response to Rx

5. alpha haemolytic strep (strep viridans)

   • commonest causative organism

6. Rx

   • penicillin+ aminoglycoside
     • 6 weeks therapy
     • check serum Abx level will kill pathogen
   • if infected prosthetic material present
     • surgical removal may be needed

7. prophylaxis

   • good dental hygiene
     • most imp factor
     • must strongly encourage in kids w/ congenital heart disease
   • Abx prophylaxis
     • no longer recommended in UK
     • may be needed in other countries for
       • any dental Rx
       • surgery, which is likely to be assoc w/ bacteraemia