Paeds: Endocarditis Flashcards
Children at risk
Those with turbulent blood flow through the heart or where prosthetic material has been inserted following surgery e.g.
- PDA or VSD
- Coarctation of aorta
- Previous rheumatic fever
Common pathogens
- Streptococcus viridans: often after dental procedures
- Staph. Aureus: related to central venous catheters
- Group D streptococcus (enterococcus): often after low GI surgery
Clinical Features:
early
Symptoms are mild
Prolonged fever over several months may be the only feature
Other presentation
acute
Rapid onset of high intermittent fever can occur
Non-specific symptoms
Myalgia and arthralgia
Headache
Weight loss
Night sweats
Examination:
- Pallor/anaemia
- Nail bed – splinter haemorrhages
- Tender nodules: fingers/toes (Oslers nodes)
- Erythematous palms/soles of feet (Janeway lesions)
- Finger clubbing (Late)
- Splenomegaly
- Haematuria (microscopic)
- Retinal infarcts (roth spots)
- Heart murmurs (change in character with time)
Diagnosis:
- Bloods:
a. FBC (raised WCC)
b. Raised ESR
c. Raised CRP
d. Repeated blood cultures - Echo look for vegetation’s
Prophylaxis: no longer routinely advised
Prophylaxis
Prophylaxis: no longer routinely advised
Treatment:
3 things
Antibiotic Therapy
Bed rest
Surgery
ABX
ASAP
Delays may result in progressive endocardial damage and deterioration in cardiac function
High dose IV antibiotics e.g. penicillin/vancomycin min. 6 weeks
Bed rest
Recommended and heart failure should be treated
Surgery
Surgery
Prognosis
- Even with antibiotic Treatment mortality may be as high as 20% and complications 950-60%) include heart failure.
- Systemic embolic from left-sided vegetation’s may result in brain abscess and stroke.
