INFECTIOUS ENDOCARDITIS IN CHILDREN - CHANGING PATTERN IN A DEVELOPING-COUNTRY

Background: There is a reported change in the profile of infectious en docarditis and a reduction in its mortality in the developed world. We present our experience of infectious endocarditis in children seen in the last 5 years in the developing world. Methods: Records of 43 cons ecutive children with infectious endocarditis admitted to this centre were analysed retrospectively. Diagnosis was based on presence of any two of the following: fever with no extracardiac features; vegetations on echocardiography; positive blood culture with no extracardiac focu s: and embolic episodes. Results: The age at diagnosis ranged from 40 days to 16 years (mean 8.5 years); Of the patients 3 were under 2 year s of age; 28 were males and 15 females. Congenital heart disease was t he underlying cause in 32 (74%), and rheumatic heart disease in 11 chi ldren. Ail except the youngest presented with fever. Blood cultures we re positive in 16 (37%). Vegetations were detected by cross-sectional echocardiography in all except 1 child. After treatment 31 (72%) respo nded to a combination of penicillin and aminoglycoside. Emergency surg ery was undertaken in 9 (21%). Three patients (7%) died, and all of th ese had fungal endocarditis. Conclusions: Blood cultures give a low yi eld, but cross-sectional echocardiography is a sensitive tool in the d iagnosis of infectious endocarditis. Most children respond to penicill in and an aminoglycoside. An aggressive surgical approach in complicat ed cases lowers the mortality.