Paediatric infective endocarditis: 19-year experience at a tertiary care hospital in a developing country

A retrospective study was undertaken to study children who presented with i nfective endocarditis (IE) to a university teaching hospital in Beirut, Leb anon, between January 1977 and May 1995. Of 41 patients with IE (24F, 17M), 28 (68%) were diagnosed between 1977 and 1985. Patients' ages ranged from 3 to 18 y (mean age 11.3 +/- 2.8 y), and 13 patients were <10 y of age. Cli nical presentations included: fever (in 88%), heart failure (in 39%), neuro logic findings (in 20%) and embolic phenomena tin 22%). Nineteen patients ( 46%) had underlying congenital heart disease (CHD with tetralogy of Fallot and pulmonary stenosis being the most common. Sixteen patients (39%) had un derlying rheumatic heart disease (RHD). A total of 5 children (12%) with no rmal cardiac anatomy had IE. One had underlying acquired viral myocarditis with mitral insufficiency. Echocardiography showed vegetations in 60%. Bloo d cultures were positive in 31 patients (76%). IE occurred in three patient s following cardiac surgery. In one patient it occurred within 2 mo of surg ery and in the other two it occurred within 6 mo. Streptococcus viridans an d Staphylococcus aureus were the two most commonly isolated bacteria. Overa ll mortality rate was 29% (not statistically significant between patients p resenting between 1977-1985 and 1986-1995; p = 0.17). Then was no statistic ally significant difference in mortality among the groups (five in the grou p with CHD, six with RHD and one with structurally normal heart). This study demonstrates that RHD is an important underlying cause of IE hi children in Our community. This finding is similar to those in other develo ping countries and different from those in developed countries. Distributio n of pathogens and CHD in our study is comparable to Some reports in the li terature, except for the higher proportion Of patients with underlying pulm onary stenosis, Bacterial endocarditis prophylaxis should be emphasized in patients With RHD or pulmonary stenosis.