Nuevas tendencias de la endocarditis pediátrica

• Autores: G. Larose, A. Carceller, M.H. Lebel, C. Boutin
• Localización: Anales de Pediatría: Publicación Oficial de la Asociación Española de Pediatría ( AEP ), ISSN-e 1696-4608, ISSN 1695-4033, Vol. 63, Nº. 5, 2005, págs. 396-402
• Idioma: español
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• Resumen

  • Objectives: To evaluate the epidemiology, etiology and evolution of a cohort of infants and children with endocarditis and to compare their main characteristics to that of our previously published experience.

    Material and methods: Patients less than 18 years of age diagnosed with endocarditis at the CHU Sainte-Justine of Montreal, between January 1986 and December 2000. The recent case series was compared to our previous experience of 1960-1985.

    Results: 56 children with endocarditis were included: 35 children with congenital heart disease, 15 with serious systemic underlying disease and 6 healthy children. Mean age was 7 years and ten months. Male sex: 54 % of the cases. The prevalence of endocarditis increased from 1.5 cases/year to 4 cases/year in the previous vs. recent case series, respectively. In the present series, ten patients (17.9 %) had a central venous catheter. Sixteen (28.6 %) patients had a vascular prosthesis. Blood cultures were positive in 50 patients (89 %) with Streptococci spp. in 48 % and Staphylococci spp. in 34 % of cases. Echocardiography was positive in 36 of 55 patients (65.4 %). All children were treated with intravenous antibiotics for an average of 43 ± 15 days. There were no recurrences. Significant complications developed in 26 patients (46 %). Embolic phenomena were seen in 11 children (20 %). Twelve patients (21 %) needed surgery. Of the six healthy children, five developed complications. Overall, seven children (12.5 %) died; all were older than six years of age. Comparing our experience of 1960-1985 to 1986-2000, morbidity and mortality has decreased from 85.7 % to 46.4 % and from 27 % to 12.5 %, respectively.

    Conclusions: Pediatricians must recognize that children with underlying immunodeficiency and those with central venous catheters have an increased risk of endocarditis. Healthy children with endocarditis have a greater risk of complications. The morbidity and mortality of endocarditis has decreased considerably in recent years.