Andersons pediatric cardiology 1481
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InfectiveEndocarditis
GeorgiChristov,GarthDixon,MartinKostolny
Abstract
Pediatricinfectiveendocarditis(IE)remainsadiagnosticandtherapeutic
challenge.IthasalowerincidenceandbetteroutcomesthanIEinadults.
Thepredisposingfactorsinhigh-incomecountrieshavechanged:although
rheumaticheartdisease–relatedIEhasdramaticallydeclined,thereisarise
ofthecongenitalheartdisease–related,postprocedural,anddevice-related
pediatricIE.ThemainstayofmanagementofIEisthemultidisciplinary
approachcoordinatedbytheendocarditisteam.CurrentguidelinesforIE
managementinadultshavebeenupdatedbytheEuropeanSocietyof
Cardiology(ESC)andAmericanHeartAssociation(AHA)in2015anda
specificpediatricstatementhasbeenissued.Surgicalguidelineshavebeen
updated2016.
TheclassicDukediagnosticcriteriahavebeenmodifiedandrecently
amended.Positivebloodculture(BC)remainsessential.Advancesin
molecularmicrobiologyanduseofpolymerasechainreaction(PCR)
techniquesallowforbetterdiagnosis.BC-negativeendocarditisrequires
serologyinvestigations,aswellasPCRonresectedmaterial.Echosignsof
IEarepresentin80%to90%ofcases.Negativeechocardiogramdoesnot
100%excludeIE.ForpediatricIE,transesophagealechoisrarelyrequired
incasesoftechnicaldifficultiesofimageacquisitionandprostheticvalve
IE.Computedtomography(CT)andpositronemissiontomography(PET)CThavebeenaddedtotheimagingmajordiagnosticcriteria.CTisa
screeningtoolforpulmonarythromboembolisminright-sidedIEandbrain
imagingforcerebralembolisminleft-sidedIE.PET-CTisinvaluablefor
prostheticvalveIEandelectronicdeviceIE.
Antibiotictreatmentismandatorilylong.ForpediatricIE,thedegreeof
illnessshouldnotbeconsideredalimitationtosurgicalintervention.Early
surgeryhasprovenadvantageincertainindications.Repairisalways
preferredtoreplacementwheneverpossible.
Keywords
pediatricinfectiveendocarditis;changingprofile;device-relatedinfective
endocarditis;vegetation;echosignsofinfectiveendocarditis;aorticroot
abscess;CTandPET-CTforIE;bloodculture;bloodculturenegative
