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Infective Endocarditis in Children : Review of 35 Cases over 11 Years(1987-1997)

Journal of the Korean Pediatric Society 2000;43(4):526-534.
Published online April 15, 2000.
Infective Endocarditis in Children : Review of 35 Cases over 11 Years(1987-1997)
Jeong Jin Yu, Young Ho Kwak, Jung-Youn Hong, He Sun Jung, Jin Young Song, Hoan Jong Lee, Chung Il Noh, Jung Yun Choi, Yong Soo Yun
Department of Pediatrics, College of Medicine, Seoul National University, Seoul, Korea
소아 감염성 심내막염의 임상양상 : 11년간(1987-1997)의 고찰
유정진, 곽영호, 홍정연, 정혜선, 송진영, 이환종, 노정일, 최정연, 윤용수
서울대학교 의과대학 소아과학교실
Abstract
Purpose
: Infective endocarditis(IE) is a serious complication in children with structural heart disease. We reviewed 35 cases of IE to identify the recent changes in the pattern of preexisting heart diseases, the spectrum of causative organisms and prognosis.
Methods
: The clinical records of children diagnosed as IE at the Seoul National University Children`s Hospital from January 1987 through December 1997, were reviewed retrospectively. Duke criteria was used for diagnosis. Cases were categorized into primary group(PG) IE in an unoperated heart and post operative group(POG), and the latter further into early POG(within 2 months after operation) and late POG.
Results
: There were 35 cases of IE developed in 34 patients; 18 cases in the PG, 6 cases in the early POG, and 11 cases in the late POG. Male to female ratio was 16 : 19. Mean age of POG, especially early POG was less than that of PG(early POG : late POG : PG=1.65 years : 6.5 years : 8.34 years, P=0.0267). Preexisting heart diseases were identified in 30 cases; rheumatic heart disease 1 case and congenital heart disease(CHD) 29 cases. Causative organisms were identified in 80%; viridans streptococci, 10 cases(33.3%); pneumococci, 2 cases; Group-D streptococci, 3 cases; staphylococci, 8 cases; Gram(-) organisms, 5 cases and Candida albicans, 2 cases. Vegetation was detected in 88.9% of PG and 64.7% of POG. The most common indication for surgery was uncontrolled infection, which were required in 9 cases. The overall mortality rate was 12.1%. Mortality in POG was higher than that of PG(23.5% versus 0%, P=0.033).
Conclusion
: The discrepancy of mean age among patient groups and the high proportion of patients belonging to POG, were consistent with the increase in the number of newly risky population that survived after cardiac surgery. A more aggressive consideration for operative management may improve the treatment results.
Key Words: Endocarditis, Duke criteria


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