Summary
In a population-based study of 41 children with bacterial endocarditis (BE), diagnosed in the period 1970 through 1989 in eastern Denmark, we analyzed trends in the diagnosis of BE and in mortality, and searched for possible prognostic factors.
During this period the delay in diagnosis from first symptom to treatment did not change, but the delay from admission to treatment was significantly prolonged from 0 to 3 days, despite the introduction of echocardiography (ECHO). There was a significant improvement in the prognosis, the mortality rate having decreased from 40 to 0% [95% confidence limits: 12–74 vs. 0–26 (0.01<p<0.02)]. The improved prognosis was not explained by changes in the etiology or pattern of antibiotic resistance and may reflect a milder course of BE in children.
Children with “mild anomalies”—such as bicuspid aortic valve (n=5), coarctation of the aorta (n=2), and prolapse of the mitral valve (n=2)—had a significantly poorer prognosis than children with other forms of congenital heart disease (CHD) (p=0.004), a reminder of the importance of suspecting BE in all children with unexplained long-lasting or intermittent fever, because some may have unrecognized “mild” CHD.
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References
Amitage P (1955) Tests for linear trends in proportional frequency.Biometrics 11:375–386
Fisher RG, Moodie DS, Rice R (1985) Pediatric bacterial endocarditis. Long-term follow-up.Cleveland Clin Q 52:41–45
Johnson CM, Rhodes KH (1982) Pediatric endocarditis.Mao Clin Proc 57:86–94
Johnson DH, Rosenthal A, Nadas AS (1975) A forty-year review of bacterial endocarditis in infancy and childhood.Circulation 51:581–588
Kaplan EL, Shulman ST (1983) Endocarditis. In: Adams FH, Emmanouilides GC (eds)Heart Diseases in Infants, Children and Adolescents. Williams & Wilkins, Baltimore, pp 565–576
Karl T, Wensley D, Stark J, Leval M de, Rees P, Taylor JFN (1987) Infective endocarditis in children with congenital heart diseases: Comparison of selected features in patients with surgical correction or palliation and those without.Br Heart J 58:57–65
Kayer R-EW, Frank DM, Byrum CJ, Blackman MS, Sondheimer HM, Bove EL (1983) Two-dimensional echocardiographic assessment of infective endocarditis in children.Am J Dis Child 137:851–856
Kramer HH, Bourgoeois M, Liersch R, Nessler, Meyer H, Sievers G (1983) Current clinical aspects of bacterial endocarditis in infancy, childhood, and adolescence.Eur J Pediatr 140:253–259
Lewis T, Grant RT (1923) Observations relating to subacute infective endocarditis.Heart 10:21–99
Mendelsohn G, Grover MH (1979) Infective endocarditis during the first decade of life.Am J Dis Child 133:619–622
Parras F, Bouza E, Romero J, Buzon L, Quore M, Brito J, Vellibre D (1990) Infectious endocarditis in children.Pediatr Cardiol 11:77–81
Roberts VC (1970) The congenitally bicuspid aortic valve. A study of 85 autopsy cases.Am J Cardiol 26:72–83
Rose AG (1987) Infective endocarditis complicating congenital heart disease.S Afr Med J 53:739–743
Schollin J, Bjarke B, Wesström G (1986) Infective endocarditis in Swedish children. Incidence, etiology, underlying factors and port of entry of infection.Acta Paediatr Scand 75:993–998
Schollin J, Bjarke B, Wesström G (1986) Infective endocarditis in Swedish children. II. Location, major complications, laboratory findings, delay of treatment, treatment and outcome.Acta Paediatr Scand 75:999–1004
Sholler GF, Hawker RE, Celermajer JM (1986) Infective endocarditis in childhood.Pediatr Cardiol 6:183–186
Wulff HR (1981)Rational Diagnosis and Treatment, 1st edn. Blackwell, Oxford, 1981
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Hansen, D., Schmiegelow, K. & Jacobsen, J.R. Bacterial endocarditis in children: Trends in its diagnosis, course, and prognosis. Pediatr Cardiol 13, 198–203 (1992). https://doi.org/10.1007/BF00838776
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DOI: https://doi.org/10.1007/BF00838776