Pediatric Infective Endocarditis: A Literature Review

Abstract

Infective endocarditis in children is a rare entity that poses multiple challenges. A history of congenital heart disease is the most common risk factor, although in recent years, other emerging predisposing conditions have gained relevance, such as central venous catheters carriers or children with chronic debilitating conditions; cases in previously healthy children with no medical history are also seen. Diagnosis is complex, although it has improved with the use of multimodal imaging techniques. Antibiotic treatment should be started early, according to causative microorganism and risk factors. Complications are frequent and continue to cause significant morbidity. Most studies have been conducted in adults and have been generalized to the pediatric population, with subsequent limitations. Our manuscript presents a comprehensive review of pediatric infective endocarditis, including recent advances in diagnosis and management.

Keywords: children; infective endocarditis; pediatrics.

Figure 1

Janeway lesions in a 15-year-old adolescent with aortic valve infective endocarditis: hemorrhagic macules of the palms and soles that are due to septic emboli.

Figure 2

A 16-year-old woman with tetralogy of Fallot and pulmonary atresia. Contegra conduit endocarditis by Streptococcus sanguis.

Figure 3

A 16-year-old male with native tricuspid valve infective endocarditis due to Viridans Streptococcus. Previous history of CHD with restrictive perimembranous ventricular septal defect, secondary moderate–severe tricuspid regurgitation, and septic pulmonary embolisms.

Figure 4

Infective endocarditis in a 13-year-old boy with bicuspid aortic valve due to Aggregatibacter aphrophilus (HACEK group). (A) Apical 5-chamber view showing aortic valve vegetation. (B) Paraesternal long axis with aortic valve showing aortic valve thickening and vegetation.