Masood Sadiq, Ahsan Waheed Rathore, Mohsin Nazir, Sheryar A Sheikh.
Infective Endocarditis in children - diagnosis in a developing country.
Pak Paed J Jan ;24(2):31-6.

Background: Infective endocarditis is difficult to diagnose in a . surpirsingly high proportion of cases. This is particularly so in a developing country like Pakistan, where patients arc referred late, there is low yield of blood cultures and incidence of rheumatic heart disease is still high. Objective: To evaluate the clinical pattern and assess diagnostic criteria in our settings. Setting: A tertiary referral center for paediatric and adult cardiology - Punjab Institute of Cardiology, Lahore Pakistan. Patients diagnosed in the department of paediatrics, King Edward Medical College, Lahore were shifted to Punjab Institute of Cardiology. Patients and methods: Forty-five patients with infective endocarditis admitted to a single tertiary referral center from April 1996 to March 1999 were analysed. The diagnosis was based on Duke`s criteria, which proposed presence of two major criteria -as positive blood cultures and positive echocardiography or one major & 3 minor criteria. Predisposing cardiac lesion, prolonged fever, vascular phenomenon like arterial or pulmonary emboli, immuological phenomenon like glomeruloncphritis, suggestive echocardiography and suggestive microbiology were taken as minor criteria. We included positive acute phase reactants like ESR and CRP and splenomegally and severe pallor as minor criteria as well. Results: By using Duke`s criteria with modification, the incidence of infective endocarditis was 32 per 1000 hospital admissions in children under 16 years of age. Rheumatic heart disease was the underlying lesion in 24 patients (53%) while congenital heart lesions in 20 patients (45%). One patient with endocarditis developed endocarditis. Blood cultures were positive in 21 patients (47%) while vegetations on echocardiography were present in 32 patients (7l%). Conclusions: Dukes criteria with modification arc acceptable diagnostic criteria in our set up. Patients in our set-up usually receive antibiotic treatment before reaching hospital, which is usually late. Rheumatic heart disease is still the commonest underlying heart lesion (53% of all patients). Blood cultures are positive in less than 50% of cases and echocardiography in expert hands is a more sensitive diagnostic tool.

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