Medical Journal of The Islamic Republic of Iran (MJIRI)

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Infective endocarditis is an uncommon heart disease with a variable incidence, mostly related to the ever-increasing development of cardiac surgery and the longer survival of patients with congenital heart disease (CHD). Thirty-seven episodes of infective endocarditis (IE) were evaluated in 36 children (under 15 years of age) admitted to hospitals affiliated to Shiraz University of Medical Sciences during a 10 year period. The mean age was 9.2 years, only one boy was under one year of age and 6 of the children were under 5. Overall, the male to female ratio was 1.46/1, but the ratio was equal in children under 5 years. The frequency of IE was 3 per 1000 pediatric admissions. CHD was the most common underlying disease (27 patients, 73.0%), followed by rheumatic heart disease (RHD) (7 patients, 18.9%). Ventricular septal defect was the most common acyanotic CHD and tetralogy of Fallot was the most common cyanotic CHD. Blood cultures were positive in 54% and vegetations were present in 57.5% by 2-dimensional echocardiography. Streptococcus species (mostly viridans) was the most common infecting micro-organism. The most common site of vegetation was the pulmonary valve, followed by the aortic valve. There were 6 deaths (16.2%) due to different causes. Mortality occurred mostly in culture negatives or in those infected by Gram-negative micro-organisms (p<0.0 1). All mortalities had left-sided vegetations (p<0.001). In conclusion, despite medical and surgical advances, this fatal complication of heart disease remains a significant medical problem. An effective chemoprophylaxis strategy for rheumatic fever and IE will decrease the incidence and outcome of this potentially serious illness.

Keywords: Bacterial endocarditis, Congenital heart disease, Rheumatic heart disease, Children, Developing countries.

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