Cardiovascular: Infective Endocarditis

Question 1

Are all children with CHD at risk of infective endocarditis?

Answer 1

Yes (except secundum ASD)

Question 2

The risk is highest when..

Answer 2

There is a turbulent jet of blood - with a VSD, coarctation of the aorta and PDA
Or if prosthetic material inserted at surgery

Question 3

When should it be suspected?

Answer 3

Sustained fever
Malaise
Raised ESR
Unexplained anaemia or haematuria

Question 4

Should the presence of the classical peripheral stigmata be relied upon?

Answer 4

No

Question 5

What clinical signs are associated?

Answer 5

Fever
Anaemia and pallor
Splinter haemorrhages in nailbed
Clubbing (late)
Necrotic skin lesions
Changing cardiac signs
Splenomegaly 
Neuro signs from cerebral infarction 
Retinal infarcts 
Arthritis/arthralgia
Haematuria (microscopic)

Question 6

How is it diagnosed?

Answer 6

Multiple blood cultures (before antibiotics)
Detailed cross section ECHO may confirm diagnosis
Acute phase reactants are raised and can be useful to monitor response to treatment

Question 7

What is the most common causative organism?

Answer 7

Alpha haemolytic streptococcus- Streptococcus viridans

Question 8

How is bacterial endocarditis usually treated?

Answer 8

High dose penicillin in combination with an aminoglycoside - 6 weeks IV
If there is infected prosthetic material, surgical removal may be required

Question 9

In terms of prophylaxis, what should be encouraged in all children with CHD?

Answer 9

Good dental hygiene

Avoidance of body piercing and tattoos

Question 10

Is antibiotic prophylaxis required in the UK for dental treatment or surgery associated with bactraemia?

Answer 10

No