1
|
AlBassri T, Sheikho M, Chaikhouni F, Al Habshan F, Kabbani MS. Neurological complications in children with infective endocarditis: Incidence, risk factors, and outcome: A 10-year single-center experience. Int J Pediatr Adolesc Med 2021; 8:198-202. [PMID: 34350336 PMCID: PMC8319676 DOI: 10.1016/j.ijpam.2021.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/26/2020] [Accepted: 02/14/2021] [Indexed: 04/13/2023]
Abstract
BACKGROUND AND OBJECTIVE Despite improvement in medical management, infective endocarditis (IE) remains a serious disease that may affect children with and without preexisting cardiac conditions with significant morbidity and mortality. Neurological complications of IE represent the worst with guarded prognosis. The aim of this study is to describe the incidence, etiology, characteristics, risk factors, and outcome of children with neurological complications associated with IE. MATERIAL AND METHODS A retrospective cohort study was conducted from 2009 to 2019 where all pediatric patients who fulfilled the modified Duke criteria for IE were included. We divided the cases into 2 groups: IE with neurological complications and IE without neurological complications control group. We compared the two groups statistically and analyzed the results. RESULTS We identified 31 (17 male, 14 female) patients with IE. Neurological complications occurred in 7/31 (23%) patients, mainly in the form of a stroke. Gram-positive microbes were the main causative agents for IE (52%) followed by gram-negative (14%), then fungal organisms (3%). Univariate analysis identified the following risk factors for neurological complications: lower body weight, higher C- reactive protein (CRP) level, and left-sided valvular lesions with P values of (0.0003, 0.0001, and 0.04), respectively.Although mortality was higher in the neurological complications group, it was 43% in comparison to 21% in the control group and it did not reach statistical significance (P = .49). Large vegetation size (more than 10 mm) was seen in 57% of patients with neurological complications as compared to 16% in the control group (P = .052). CONCLUSION Neurological complications occurred in almost a quarter of children with IE. Possible risk factors include lower body weight, left-sided valvular lesion, and higher levels of inflammatory markers (CRP). Stroke was the most common neurological complication encountered with possible increased risk of mortality.
Collapse
Affiliation(s)
- Tala AlBassri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Maha Sheikho
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Farah Chaikhouni
- Division of Pediatric Cardiology, Department of Cardiac Sciences, King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Fahad Al Habshan
- Division of Pediatric Cardiology, Department of Cardiac Sciences, King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mohamed S. Kabbani
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Division of Pediatric Cardiac Intensive Care, Department of Cardiac Sciences, King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- Corresponding author. Pediatric Cardiac ICU, MC 1423, King Abdulaziz Medical City, P.O. BOX 22490, Riyadh, 11426, Saudi Arabia.
| |
Collapse
|
2
|
Ravindranath Waikar A, Uzamere O, Bailey K, Pierre L, Adeyinka A. A Unique Pathogen Causing Infective Endocarditis in a Three-year-old Girl. Cureus 2019; 11:e4249. [PMID: 31131172 PMCID: PMC6516622 DOI: 10.7759/cureus.4249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The overall incidence of infective endocarditis (IE) in adults has been reported to be 1.5 to 6.0 per 100,000 patient-years. In children, the incidence of IE in the general population is approximately three times lower. The presence of cyanotic congenital heart disease is considered to be the most strongly associated risk factor to develop IE. In approximately 8% to 10% of pediatric cases, IE develops without structural heart disease or any other readily identifiable risk factors. In these situations, the infection usually involves the aortic or mitral valve secondary to Staphylococcus aureus bacteremia. Streptococcus pneumoniae endocarditis in a female with no known risk factors is extremely rare and has no established optimal therapy. We hereby present a case of a three-year-old girl, with no identifiable risk factors diagnosed with IE caused by S. pneumoniae.
Collapse
|
3
|
Geslain G, Bourgade C, Chomton M, Le Bourgeois F. Methicillin-sensible Staphylococcus aureus causing endocarditis, with cerebral and orthopaedic complications, in a 17-month-old child with no risk factor. BMJ Case Rep 2018; 2018:bcr-2018-226388. [PMID: 30317206 DOI: 10.1136/bcr-2018-226388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a case of Staphylococcus aureus endocarditis, with large vegetation, in a 17-month-old male infant, complicated with meningitis, ischaemic strokes and osteoarthritis leading to haemorrhagic stroke by aneurysm rupture. He did not present any risk factor for endocarditis. The final course was favourable through, after valve replacement. The strain was sensible to methicillin and belongs to complex clonal 398, with accessory gene regulator I. We did not found immunodeficiency.
Collapse
Affiliation(s)
- Guillaume Geslain
- Paediatric Mobile Emergency and Intensive Care Units, Hopital Universitaire Robert-Debre, Paris, France.,Hopital Universitaire Robert-Debre, Department of Microbiology, Paris, France
| | - Clara Bourgade
- Department of Pediatric Cardiology, Hopital Universitaire Robert-Debre, Paris, France
| | - Maryline Chomton
- Paediatric Mobile Emergency and Intensive Care Units, Hopital Universitaire Robert-Debre, Paris, France
| | - Fleur Le Bourgeois
- Paediatric Mobile Emergency and Intensive Care Units, Hopital Universitaire Robert-Debre, Paris, France
| |
Collapse
|
4
|
Ba DM, Mboup MC, Zeba N, Dia K, Fall AN, Fall F, Fall PD, Gning SB. Infective endocarditis in Principal Hospital of Dakar: a retrospective study of 42 cases over 10 years. Pan Afr Med J 2017; 26:40. [PMID: 28451018 PMCID: PMC5398261 DOI: 10.11604/pamj.2017.26.40.10020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 09/22/2016] [Indexed: 12/19/2022] Open
Abstract
Infective Endocarditis (IE) is an endocardial infection usually caused by bacteria that affects not only the native heart valves but also, with increasing frequency intravascular implanted devices and congenital heart diseases. Despite medical advances, IE remains a life-threatening disease with substantial morbidity and mortality. In Africa, its diagnosis and treatment are still a major challenge in clinical practice. The objective of this work was to study the epidemiological, clinical features, diagnostic techniques currently used in medical practice and the range of micro-organisms that are responsible. This was a retrospective study done at Principal Hospital of Dakar. We include all patients who were admitted with clinical manifestations of definite or possible IE according to the extended DUKE criteria between January 1st, 2005 and December 31st, 2014. We collected and analyzed epidemiological, clinical, paraclinical and outcomes data of 42 patients. Hospital prevalence of IE was 0.078% (42/53711). The mean age was 27.5+/- 18 years with a sex ratio (M/F) of 0.55. IE were more common in patients with damaged or abnormal heart valves (78.6%) and in thoses with underlying structural defects (14.3%). The most common presenting symptoms were fever (90%) and cardiac murmurs (81%). Extracardiac clinical manifestations were very rare. The usual laboratory parameters of inflammation were elevated in 90% of patients. Blood cultures were negative in 50% of cases and positive in 21.4%. The main organism found was Staphylococcus aureus. Echocardiography found vegetations in 95.2% of cases, chamber enlargement in 73.8% and mitral regurgiation in 83.3%. Broad-spectrum penicillins including ampicillin and gentamycine were used for all patients. Major complications were heart failure (47.6%). Strokes and cerebral abcess (23.8%) and Vascular emboli 14.3%. Hospital mortality was 31%. IE remains a life-threatening disease with hight mortality despites improved techniques of diagnosis and modern antibiotics.
Collapse
Affiliation(s)
- Djibril Marie Ba
- Department of Cardiology, Principal Hospital of Dakar, Dakar, Senegal
| | | | - Nafissatou Zeba
- Department of Internal Medicine, Principal Hospital of Dakar, Dakar, Senegal
| | - Khadidiatou Dia
- Department of Cardiology, Principal Hospital of Dakar, Dakar, Senegal
| | - Awa Ndaw Fall
- Department of Internal Medicine, Principal Hospital of Dakar, Dakar, Senegal
| | - Fatou Fall
- Department of Internal Medicine, Principal Hospital of Dakar, Dakar, Senegal
| | - Pape Diadie Fall
- Department of Cardiology, Principal Hospital of Dakar, Dakar, Senegal
| | - Sara Boury Gning
- Department of Internal Medicine, Principal Hospital of Dakar, Dakar, Senegal
| |
Collapse
|
5
|
Esposito S, Mayer A, Krzysztofiak A, Garazzino S, Lipreri R, Galli L, Osimani P, Fossali E, Di Gangi M, Lancella L, Denina M, Pattarino G, Montagnani C, Salvini F, Villani A, Principi N, Italian Pediatric Infective Endocarditis Registry. Infective Endocarditis in Children in Italy from 2000 to 2015. Expert Rev Anti Infect Ther 2016; 14:353-8. [PMID: 26708337 DOI: 10.1586/14787210.2016.1136787] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The Italian Society for Pediatric Infectious Diseases created a registry on children with infective endocarditis (IE) hospitalized in Italy. METHODS A cross-sectional survey was conducted on patients hospitalized due to IE in Italian paediatric wards between January 1, 2000, and June 30, 2015. RESULTS Over the 15-year study period, 47 IE episodes were observed (19 males; age range, 2-17 years). Viridans Streptococci were the most common pathogens among patients with predisposing cardiac conditions and Staphylococcus aureus among those without (37.9% vs. 5.5%, p = 0.018, and 6.9% vs. 27.8%, p = 0.089, respectively). Six of the 7 (85.7%) S. aureus strains were methicillin-resistant. The majority of patients with and without predisposing cardiac conditions recovered without any complications. CONCLUSION In Italy, paediatric IE develops without any previous predisposing factors in a number of children, methicillin-resistant S. aureus has emerged as a common causative agent and the therapeutic approach is extremely variable.
Collapse
Affiliation(s)
- Susanna Esposito
- a Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation , Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - Alessandra Mayer
- a Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation , Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - Andrzej Krzysztofiak
- b Unit of General Pediatrics and Pediatric Infectious Diseases , IRCCS Bambino Gesù Hospital , Rome , Italy
| | - Silvia Garazzino
- c Pediatric Infectious Diseases Unit, Regina Margherita Children's Hospital , University of Turin , Turin , Italy
| | - Rita Lipreri
- d Pediatric Unit , Niguarda Hospital , Milan , Italy
| | - Luisa Galli
- e Paediatric Infectious Disease Unit, Department of Health Sciences , University of Florence, Anna Meyer Children's University Hospital , Florence , Italy
| | - Patrizia Osimani
- f Pediatric Infectious Diseases Unit , Salesi Hospital , Ancona , Italy
| | - Emilio Fossali
- g Emergency Room Unit , Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - Maria Di Gangi
- h Pediatric Infectious Diseases Unit , Di Cristina Hospital , Palermo , Italy
| | - Laura Lancella
- b Unit of General Pediatrics and Pediatric Infectious Diseases , IRCCS Bambino Gesù Hospital , Rome , Italy
| | - Marco Denina
- c Pediatric Infectious Diseases Unit, Regina Margherita Children's Hospital , University of Turin , Turin , Italy
| | | | - Carlotta Montagnani
- e Paediatric Infectious Disease Unit, Department of Health Sciences , University of Florence, Anna Meyer Children's University Hospital , Florence , Italy
| | - Filippo Salvini
- i Pediatric Clinic, San Paolo Hospital , University of Milan , Milan , Italy
| | - Alberto Villani
- b Unit of General Pediatrics and Pediatric Infectious Diseases , IRCCS Bambino Gesù Hospital , Rome , Italy
| | - Nicola Principi
- a Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation , Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | | |
Collapse
|
6
|
Baltimore RS, Gewitz M, Baddour LM, Beerman LB, Jackson MA, Lockhart PB, Pahl E, Schutze GE, Shulman ST, Willoughby R. Infective Endocarditis in Childhood: 2015 Update. Circulation 2015; 132:1487-515. [DOI: 10.1161/cir.0000000000000298] [Citation(s) in RCA: 201] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|
7
|
Marom D, Ashkenazi S, Samra Z, Birk E. Infective endocarditis in previously healthy children with structurally normal hearts. Pediatr Cardiol 2013; 34:1415-21. [PMID: 23483241 DOI: 10.1007/s00246-013-0665-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 02/09/2013] [Indexed: 12/20/2022]
Abstract
Structural heart disease, intravascular catheters, and invasive procedures are predisposing factors for infective endocarditis (IE). Data on IE in children with structurally normal hearts and no predisposing factors are limited. We aim to characterize IE (definite or possible by Duke criteria) in such a subgroup of pediatric patients (age <18 years) who were treated at our medical center. Of 51 events of IE in 50 children, 9 (18 %) had no predisposing factors. These infections were all community-acquired and presented with fever, a newly detected heart murmur, diagnostic echocardiographic findings, and left-sided infection. Clinical course was characterized by acute onset (n = 8 of 9) with a 100 % complication rate (heart failure or embolic phenomena). Emergency cardiac surgery was performed in 7 children (Ross surgery [n = 4], mitral valve replacement [MVR; n = 2], and valve repair [n = 1]). Causative organisms were S. aureus (n = 3), S. pneumoniae (n = 2), H. parainfluenzae (n = 1), and K. kingae (n = 1). In contrast, IE in children with predisposing factors (42 of 51 [82 %]) was frequently health care-associated (30 of 42), right-sided (20 of 42, p = 0.041), and with lower rates of diagnostic echocardiographic findings (28 of 42, p = 0.041), complications (16 of 42, p < 0.001), and surgical intervention (9 of 42, p = 0.002). Causative organisms were mainly viridans streptococci (n = 9), Candida species (n = 8), coagulase-negative staphylococci (n = 6), enteric Gram-negative bacilli (n = 6), S. aureus (n = 5), and K. kingae (n = 3). Mortality was 11 % in both groups. We conclude that pediatric IE in children with and without predisposing factors differs significantly. Due to the acute and complicated course of the latter, high awareness among pediatricians and prompt diagnosis are crucial.
Collapse
Affiliation(s)
- Daphna Marom
- Department of Pediatrics A, Schneider Children's Medical Center, Petach Tikva, Israel.
| | | | | | | |
Collapse
|
8
|
El Alami S, Handor N, Moutaki Allah Y, Bouchrik M, El Mellouki W, Boulahya A, Lmimouni B. [Candida albicans endocarditis after treatment of complete atrioventricular canal]. J Mycol Med 2013; 23:185-8. [PMID: 23896621 DOI: 10.1016/j.mycmed.2013.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 06/17/2013] [Accepted: 06/18/2013] [Indexed: 10/26/2022]
Abstract
Infective endocarditis is rare in children, it is rarer after a surgical treatment of atrioventricular canal, and it is exceptional that Candida albicans is the etiologic agent. This is a serious infection found in congenital heart disease with or without surgery. It is potentially lethal, despite diagnostic and therapeutic advances. We report a case of infective endocarditis due to C. albicans after the treatment of a congenital systemic atrioventricular canal in a child with trisomy 21. The diagnosis was suspected on clinical manifestations and cardiac auscultation. Confirmation was provided by positive blood cultures and echocardiography. The large size of the vegetation in the patient was in favor of a fungal etiology, blood cultures allowed to identify the fungus. This observation illustrates a poorly understood disease, with very poor prognosis and which is a potential complication of heart surgery. The improved prognosis should be achieved by shortening the time to diagnosis and optimizing the therapeutic support.
Collapse
Affiliation(s)
- S El Alami
- Service de parasitologie mycologie, hôpital militaire d'instruction Mohammed V, Rabat, Morocco
| | | | | | | | | | | | | |
Collapse
|