BACTERIAL-ENDOCARDITIS IN CHILDHOOD

Background Bacterial endocarditis in childhood is a rare but serious d isease. The group of children with congenital heart disease at risk to develop bacterial endocarditis increases, because more children survi ve with advanced medical and surgical managment. Rheumatic Fever as pr edisposing heart disease decreases and is of reduced importance. Patie nts From 1983 to 1993 16 patients in the age of 0.3 to 17.6 years (mea n 10.6 years) were received by the Department of Pediatric Cardiology of the University Children's Hospital Vienna with the diagnosis ''bact erial 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 va lve, and 1 child had a coronary artery fistula. Moreover, 1 child had a mitral valve prolapse with valvular regurgitation as a consequence o f Marfan-Syndrome. 6 children with congenital heart disease had been t reated surgically previously. Methods Medical data of all patients wit h the diagnosis of ''bacterial endocarditis'' between 1983 and 1993 we re 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 Streptoco ccus viridans (4 cases) and Staphylococcus aureus (3 cases) were isola ted. During the parenteral therapy with antibiotics 9 children suffere d as a side effect from a drug induced fever and/or decreasing leucocy tes and thrombocytes or a rash. In addition to the antibiotic therapy 8 children were treated surgically. One child died immediately after t he operation. 15 of the 16 patients with endocarditis survived. Conclu sions With children with known heart disease the recommendations for t he prevention of bacterial endocarditis have to be strictly followed a nd every long ongoing feverish disease has to be carefully examinated.