Masood Sadiq, Ahsan Waheed Rathore, Mohsin Nazir, Sheryar A Sheikh.
Management and outcome of children with Infective Endocarditis.
Pak Paed J Jan ;24(2):37—41.

Background: Infective endocarditis remains an important cause of morbidity and mortality in paediatric age group. The pattern of disease seems to have changed and mortality is significantly reduced in the -developed world. In developing countries like Pakistan, patients are referred late: majority come from a poor socioeconomic background and mortality is still high. Objective: To evaluate the management and determine outcome in our own settings. Setting: A tertiary referral center for paediatric and adult cardiology - Punjab Institute of Cardiology Lahore Pakistan. Patients were also shifted from Mayo Hospital/KEMC, Lahore. 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 with addition of raised acute phase reactants and splenomegally. Thus has already been described in a separate paper. The data on management and outcome was clearly documented. Results: The incidence of infective endocarditis was 32 per 1000 hospital admissions in children under l6 years of age. Rheumatic heart disease was the commonest lesion (24 patients) while congenital heart lesions in 20 patients (45%). Previous antibiotic treatment was given in 26 patients (58%) definitely. Streptococcus Viridians was the commonest organism on blood cultures. Majority of patients (35 pts - 80%) responded to a combination of Benzathine Penicillin and gentamycin. Surgery was undertaken in 4 patients and 5 patients left against medical advise. Of 10 patients with aortic valve involvement, there were 3 deaths (30%) and overall mortality was 13% (6 Pts.) Conclusions: The incidence of infective endocarditis is 32 per hospital admissions in a tertiary paediatric cardiology referral center. Patients in our set-up usually receive antibiotic treatment before reaching hospital, which is usually late. Majority respond to a penicillin and aminoglycoside combination. Mortality is still high and aortic valve involvement in particular, carried poor prognosis.

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