Masood Sadiq, Ahsan Waheed Rathore, Mohsin Nazir, Sheryar A Sheikh.
Infective Endocarditis in children: Diagnosis and management in a developing country.
Pak Paed Cardiol J Jan ;2(1-2):9-14.

Infective endocarditis remains an important cause of morbidity and mortality in paediatric age group. In the developed world the pattern of the disease appears to have changed and mortality has been significantly reduced. The pattern of infective endocarditis in children admitted to Punjab Institute of Cardiology Lahore, over the last three yeas was reviewed. The aim of the study was to evaluate the clinical profile, assess the reliability of the diagnostic criteria in our settings and suggest management protocols commensurate with our limited resources. Forty-five patients with infective endocarditis admitted or transferred to a tertiary referral centre during April 1996 to March 1999 were analysed. Eight patients diagnosed at Mayo Hospital were transferred to Punjab Institute of Cardiology. The diagnosis was based on presence of two major criteria i.e. vegetations on echocardiography and positive blood cultures or one major and more than 2 minor criteria. Rheumatic heart disease was the underlying lesion in 24 patients while congenital heart lesions in 20 patients. One patient with myocarditis developed endocarditis. Antibiotic treatment had been given in 26 patients prior to admission. Blood cultures were positive in 2" patients while vegetations on echocardiography were present in 32 patients. Streptococcus viridans was the commonest organism grown on blood cultures. Majority of patients 35 responded to a combination of Penicillin and aminoglycoside. Surgery was undertaken in 4 patients and overall mortality was 11%. We conclude that patients in Pakistan usually receive antibiotic treatment prior to reaching hospital, which is usually late. Rheumatic heart disease was the commonest underlying heart lesion. Blood cultures were positive in less than 50% of cases. Echocardiography in expert hands was more sensitive. Majority responded to Penicillin and aminoglycoside combination. Aortic valve involvement tends to carry poor prognosis.

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