Editorial Comment Cardiology 2014;128:86–87 DOI: 10.1159/000358551
Received: January 11, 2014 Accepted: January 11, 2014 Published online: March 21, 2014
Update in Pediatric Infective Endocarditis Ira Gelb Xupei Huang Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Fla., USA
© 2014 S. Karger AG, Basel 0008–6312/14/1282–0086$39.50/0 E-Mail [email protected] www.karger.com/crd
sufficiency with CHF resulted in a high mortality rate. However, atrial septal defect (secundum), fully repaired ventricular septal defect and patent ductus arteriosus were not IE risk factors. In general, this study based on pediatric patients from a mid-west area of China confirms that most recent pediatric IE cases are associated with structural heart disorders and congenital heart disease (CHD), whereas the rate of pediatric IE associated with rheumatic heart disease is decreasing. This is consistent with the studies reported in the USA that rheumatic heart disease is now rarely associated with endocarditis [2]. Regarding the pathogens, Staphylococcus aureus is still the predominate pathogenic organism affecting the inner part of the heart in children, consistent with the American report that S. aureus is an important agent among children with CHD and IE [4]. Interestingly, Wang et al. [3] reported in their study that right-sided IE (RSIE) and tricuspid valves become more frequently involved in pediatric IE patients. One of the possible explanations is that the increase in RSIE might be related to the high incidence of CHD in the studied subjects since many studies indicate that CHD is the most prevalent predisposing factor for RSIE [5]. However, this finding is not conclusive because of the limited subjects enrolled in the study. More studies are needed to Ira J. Gelb, MD, Clinical Professor, Assistant Dean Charles E. Schmidt College of Medicine Florida Atlantic University Boca Raton, FL 33431 (USA) E-Mail junegelb @ aol.com
Downloaded by: Univ.of Adelaide 129.127.145.240 - 10/5/2017 4:36:19 AM
Infective endocarditis (IE) is an infection of the endocardium of the heart. In the US, the incidence of IE in children is approximately 1 case per 1,000 pediatric hospital admissions [1]. This incidence has remained essentially unchanged over the past 40 years, but the distribution of etiologies has shifted [2]. Recent epidemiologic studies on pediatric IE, especially in the US and European countries, have enriched our understanding of pediatric IE, which is useful for the prevention and treatment of the disease. However, little knowledge on IE epidemiology and its etiologic changes in pediatric patients has been gained from studies in Asian and African countries. The article of Wang et al. [3] in this issue of Cardiology entitled ‘Retrospective Studies on Pediatric Infective Endocarditis over 40 Years in a Mid-West Area of China’ highlights critical changes in the epidemiology of pediatric IE. Notably, the lesions became more prevalent in the right heart (tricuspid valve) in the years 2000–2011 compared to 1964–1999. The incidence of IE, however, remains essentially unchanged at 0.01% in the US. Preexisting cardiac pathology is evident in 75–90% of children with IE. Indwelling catheters and interventional therapy for IE in neonates with normal cardiac anatomy were major factors for IE in this age group. The mortality rate ranges between 16 and 25% primarily due to congestive heart failure (CHF) or systemic emboli. Acute aortic in-
References
Pediatric Infective Endocarditis
because of further improvements in diagnostic techniques and new intracardiac procedures. The key to detecting IE in any age group remains the ‘index of suspicion’. Importantly, resistant organisms will continue to replace S. aureus and Streptococcus viridians in the future. The objectives remain that early diagnosis with appropriate drug/surgical therapy could be curative and life saving.
1 Pasquali S, He X, Mohamad Z, McCrindle BW, Newburger JW, Li JS, Shah SS: Trends in endocarditis hospitalizations at US children’s hospitals. Am Heart J 2012;163:894–899. 2 Gewitz MH: Pediatric bacterial endocarditis. Medscape, Nov 4, 2013, http://emedicine. medscape.com/article/896540-clinical. 3 Wang W, Sun H, Lv T, Tian J: Retrospective studies on pediatric infective endocarditis over 40 years in a mid-west area of China. Cardiology 2014;128:88-91.
Cardiology 2014;128:86–87 DOI: 10.1159/000358551
4 McNeil JC, Ligon JA, Hulten KG, Dreyer WJ, Heinle JS, Mason EO, Kaplan SL: Staphylococcus aureus infections in children with congenital heart disease. J Ped Infect Dis 2013;2:337– 344. 5 Micheletti A, Negura D, Piazza L, et al: Infective endocarditis in patients with congenital heart disease. Pediatr Med Chir 2010;32:270– 273.
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confirm the incidence of RSIE in pediatric IE cases. RSIE epidemiology in children and neonates is generally secondary to organic pathology unlike the use of illicit intravenous drugs as seen in adults. More sophisticated diagnostic evaluations and additional therapy play a major role in the changes evident in neonates and children in recent years. Ongoing studies will continue to affect our knowledge on IE epidemiology
Received: January 11, 2014 Accepted: January 11, 2014 Published online: March 21, 2014
Update in Pediatric Infective Endocarditis Ira Gelb Xupei Huang Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Fla., USA
© 2014 S. Karger AG, Basel 0008–6312/14/1282–0086$39.50/0 E-Mail [email protected] www.karger.com/crd
sufficiency with CHF resulted in a high mortality rate. However, atrial septal defect (secundum), fully repaired ventricular septal defect and patent ductus arteriosus were not IE risk factors. In general, this study based on pediatric patients from a mid-west area of China confirms that most recent pediatric IE cases are associated with structural heart disorders and congenital heart disease (CHD), whereas the rate of pediatric IE associated with rheumatic heart disease is decreasing. This is consistent with the studies reported in the USA that rheumatic heart disease is now rarely associated with endocarditis [2]. Regarding the pathogens, Staphylococcus aureus is still the predominate pathogenic organism affecting the inner part of the heart in children, consistent with the American report that S. aureus is an important agent among children with CHD and IE [4]. Interestingly, Wang et al. [3] reported in their study that right-sided IE (RSIE) and tricuspid valves become more frequently involved in pediatric IE patients. One of the possible explanations is that the increase in RSIE might be related to the high incidence of CHD in the studied subjects since many studies indicate that CHD is the most prevalent predisposing factor for RSIE [5]. However, this finding is not conclusive because of the limited subjects enrolled in the study. More studies are needed to Ira J. Gelb, MD, Clinical Professor, Assistant Dean Charles E. Schmidt College of Medicine Florida Atlantic University Boca Raton, FL 33431 (USA) E-Mail junegelb @ aol.com
Downloaded by: Univ.of Adelaide 129.127.145.240 - 10/5/2017 4:36:19 AM
Infective endocarditis (IE) is an infection of the endocardium of the heart. In the US, the incidence of IE in children is approximately 1 case per 1,000 pediatric hospital admissions [1]. This incidence has remained essentially unchanged over the past 40 years, but the distribution of etiologies has shifted [2]. Recent epidemiologic studies on pediatric IE, especially in the US and European countries, have enriched our understanding of pediatric IE, which is useful for the prevention and treatment of the disease. However, little knowledge on IE epidemiology and its etiologic changes in pediatric patients has been gained from studies in Asian and African countries. The article of Wang et al. [3] in this issue of Cardiology entitled ‘Retrospective Studies on Pediatric Infective Endocarditis over 40 Years in a Mid-West Area of China’ highlights critical changes in the epidemiology of pediatric IE. Notably, the lesions became more prevalent in the right heart (tricuspid valve) in the years 2000–2011 compared to 1964–1999. The incidence of IE, however, remains essentially unchanged at 0.01% in the US. Preexisting cardiac pathology is evident in 75–90% of children with IE. Indwelling catheters and interventional therapy for IE in neonates with normal cardiac anatomy were major factors for IE in this age group. The mortality rate ranges between 16 and 25% primarily due to congestive heart failure (CHF) or systemic emboli. Acute aortic in-
References
Pediatric Infective Endocarditis
because of further improvements in diagnostic techniques and new intracardiac procedures. The key to detecting IE in any age group remains the ‘index of suspicion’. Importantly, resistant organisms will continue to replace S. aureus and Streptococcus viridians in the future. The objectives remain that early diagnosis with appropriate drug/surgical therapy could be curative and life saving.
1 Pasquali S, He X, Mohamad Z, McCrindle BW, Newburger JW, Li JS, Shah SS: Trends in endocarditis hospitalizations at US children’s hospitals. Am Heart J 2012;163:894–899. 2 Gewitz MH: Pediatric bacterial endocarditis. Medscape, Nov 4, 2013, http://emedicine. medscape.com/article/896540-clinical. 3 Wang W, Sun H, Lv T, Tian J: Retrospective studies on pediatric infective endocarditis over 40 years in a mid-west area of China. Cardiology 2014;128:88-91.
Cardiology 2014;128:86–87 DOI: 10.1159/000358551
4 McNeil JC, Ligon JA, Hulten KG, Dreyer WJ, Heinle JS, Mason EO, Kaplan SL: Staphylococcus aureus infections in children with congenital heart disease. J Ped Infect Dis 2013;2:337– 344. 5 Micheletti A, Negura D, Piazza L, et al: Infective endocarditis in patients with congenital heart disease. Pediatr Med Chir 2010;32:270– 273.
87
Downloaded by: Univ.of Adelaide 129.127.145.240 - 10/5/2017 4:36:19 AM
confirm the incidence of RSIE in pediatric IE cases. RSIE epidemiology in children and neonates is generally secondary to organic pathology unlike the use of illicit intravenous drugs as seen in adults. More sophisticated diagnostic evaluations and additional therapy play a major role in the changes evident in neonates and children in recent years. Ongoing studies will continue to affect our knowledge on IE epidemiology
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