Infective Endocarditis

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CLINICAL DESCRIPTION

Infection of the endocardium, mostly affecting the valves.

CLINICAL FEATURES

SIGNS AND SYMPTOMS

Duke’s criteria 

Major Criteria 

  1. Blood culture positive for typical microorganism (e.g., Staphylococcus aureus, Enterococcus, Viridans streptococcus)
  2. Echocardiogram showing valvular vegetation

Minor Criteria

  1. Predisposing cardiac lesion
  2. Temperature >38°C
  3. Embolic phenomena (e.g., stroke, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjuctival haemorrhage or Janeway lesions)
  4. Immunologic phenomena (e.g., glomerulonephritis, Osler’s nodes, Roth spots, positive rheumatoid factor)
  5. Positive blood culture not meeting above criteria

Definite infective Endocarditis 

  • 2 major or 1 major plus 3 minor criteria

Possible Infective Endocarditis

  • 1 major and 1 minor OR 3 minor criteria  

INVESTIGATIONS

  • FBC, blood culture: 3 samples, 12 hours apart, inflammatory markers: ESR, CRP, urine dipstick, echocardiography

TREATMENT 

  • IV Benzyl Penicillin (50 000 IU/kg every 4-6 hours for 6 weeks and
  • Gentamicin IV (3 mg/kg OD) for 2 weeks and
  • IV Flucloxacillin 50mg/kg (to max 2g) IV QDS for 6 weeks

OR

  • IV Benzyl Penicillin 50 000 IU/kg IV every 6 hours for 6 weeks and Gentamicin 3mg/kg IV od for 2 weeks. Please monitor renal function when giving gentamicin.

OR

  • Ceftriaxone 100mg/kg (to max 2g) IV OD for 6 weeks

Adjust antibiotics as guided by culture and sensitivity.  

Complications

  • Stroke
  • Metastatic infection (e.g., septic pulmonary infarcts, gangrenous foot)
  • Thromboembolic phenomenon

Referral

All children with infective endocarditis to tertiary facility.