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Infective endocarditis in paediatric population

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Abstract

Infective endocarditis is very uncommon in children; however, when it does arise, it can lead to severe consequences. The biggest risk factor for paediatric infective endocarditis today is underlying congenital heart defects. The most common causative organisms are Staphylococcus aureus and the viridans group of streptococci. The spectrum of symptoms varies widely in children and this produces difficulty in the diagnosis of infective endocarditis. Infective endocarditis in children is reliant on the modified Duke criteria. The use of blood cultures remains the most effective microbiological test for pathogen identification. However, in blood culture–negative infective endocarditis, serology testing and IgG titres are more effective for diagnosis. Imaging techniques used include echocardiograms, computed tomography and positron emission tomography. Biomarkers utilised in diagnosis are C-reactive protein, with recent literature reviewing the use of interleukin-15 and C-C motif chemokine ligand for reliable risk prediction. The American Heart Association (AHA) and European Society of Cardiology (ESC) guidelines have been compared to describe the differences in the approach to infective endocarditis in children. Medical intervention involves the use of antimicrobial treatment and surgical interventions include the repair and replacement of cardiac valves. Quality of life is highly likely to improve from surgical intervention.

Conclusion: Over the past decades, there have been great advancements in clinical practice to improve outcomes in patients with infective endocarditis. Nonetheless, further work is required to better investigative and manage such high risk cohort.

What is Known:

• The current diagnostic techniques including ‘Duke’s criteria’ for paediatric infective endocarditis diagnosis

• The current management guidelines utilised for paediatric infective endocarditis

What is New:

• The long-term outcomes of patients that underwent medical and surgical intervention

• The quality of life of paediatric patients that underwent medical and surgical intervention

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Abbreviations

AHA:

The American Heart Association

BCNE:

Blood culture–negative endocarditis

CCF4:

C-C motif chemokine ligand

CHD:

Congenital heart disease

CRP:

C-reactive protein

CT:

Computed tomography

ESC:

European Society of Cardiology

FDG-PET/CT:

F-Fluorodeoxyglucose-positron emission tomography

HF:

Heart failure

IE:

Infective endocarditis

PA:

Pulmonary atresia

PE:

Pulmonary embolism

RVOT:

Right ventricular outflow tract

TOE:

Transoesophageal echocardiogram

TOF:

Tetralogy of Fallot

TTE:

Transthoracic echocardiogram

VSD:

Ventricular septal defect

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Authors and Affiliations

  1. School of Medicine, Faculty of Health and Life Science, University of Liverpool, Liverpool, UK

    Loay Eleyan & Ameer Ahmed Khan

  2. Imperial College London, Exhibition Road, South Kensington, London, SW7 2BU, UK

    Gledisa Musollari

  3. University of Glasgow, Medical school, University Avenue, G12 8QQ, Glasgow, UK

    Ashwini Suresh Chandiramani

  4. St. Georges University of London, Cranmer Terrace, Tooting, London, SW17 0RE, UK

    Simran Shaikh & Ahmad Salha

  5. Department of Paediatric Cardiology, Alder Hey Children’s Hospital, Liverpool, UK

    Abdulla Tarmahomed

  6. Department of Congenital Cardiac Surgery, Alder Hey Children Hospital, Liverpool, UK

    Amer Harky

  7. Department of Cardio-thoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK

    Amer Harky

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  1. Loay Eleyan
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  2. Ameer Ahmed Khan
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L.E has contributed to writing the manuscript, editing and approving the final manuscript; A.K. has contributed to writing the manuscript, editing and approving the final manuscript; G.M. has contributed to writing the manuscript, editing and approving the final manuscript; A.C. has contributed to writing the manuscript, editing and approving the final manuscript; S.S. has contributed to writing the manuscript, editing and approving the final manuscript; A.S. has contributed to writing the manuscript, editing and approving the final manuscript; A.T. contributed to reviewing the draft manuscript, critically appraising, amending and approving the final manuscript; A.H come up with the topic, design of the study, critically reviewed the manuscript and edited it and wrote the manuscript as well as approved the final manuscript.

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Correspondence to Amer Harky.

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Eleyan, L., Khan, A.A., Musollari, G. et al. Infective endocarditis in paediatric population. Eur J Pediatr 180, 3089–3100 (2021). https://doi.org/10.1007/s00431-021-04062-7

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