Coutlée F, Carceller A M, Deschamps L, Kratz C, Lapointe J R, Davignon A
Department of Microbiology and Immunology, Université de Montréal, Québec.
Can J Cardiol. 1990 May;6(4):164-70.
A diagnosis of endocarditis was made in 37 patients (three days to 21 years old) on the basis of the following: histology in 11; at least two positive blood cultures in patients with underlying cardiac disease in 22; less than two positive blood cultures, vegetations seen at echocardiography and a suggestive clinical syndrome in four. Twenty-six patients had primary endocarditis (17 with pre-existing cardiopathy, nine with normal hearts). The 11 others developed secondary endocarditis following heart surgery (early onset in six, late onset in five). The mean delay before diagnosis was prolonged 35.8 days. The clinical and laboratory findings included weakness in 36 patients, fever in 35, new or modified heart murmur in 14, positive blood cultures in 30, anemia in 12, high white blood cell count in 15, increased sedimentation rate in 14, and positive echocardiogram in 11. Etiologic agents isolated were: streptococci in 17, staphylococci in seven, miscellaneous germs in eight, and aspergillus in two. Mortality was greater in patients less than one year old, infected with aspergillus or without underlying heart disease. The present study suggests that childhood endocarditis remains uncommon but presents a poor prognosis with a mortality of 27% and a morbidity of 85.7%.
37例患者（年龄3天至21岁）被诊断为心内膜炎，诊断依据如下：11例依靠组织学检查；22例有基础心脏病的患者血培养至少两次阳性；4例血培养阳性次数少于两次、超声心动图发现赘生物且有提示性临床综合征。26例患者为原发性心内膜炎（17例有预先存在的心脏病，9例心脏正常）。其他11例在心脏手术后发生继发性心内膜炎（6例为早发，5例为晚发）。诊断前的平均延迟时间延长至35.8天。临床和实验室检查结果包括：36例患者有虚弱症状，35例发热，14例有新的或改变的心脏杂音，30例血培养阳性，12例贫血，15例白细胞计数升高，14例血沉加快，11例超声心动图阳性。分离出的病原体有：17例为链球菌，7例为葡萄球菌，8例为其他病菌，2例为曲霉菌。1岁以下、感染曲霉菌或无基础心脏病的患者死亡率更高。本研究表明，儿童心内膜炎仍然不常见，但预后较差，死亡率为27%，发病率为85.7%。
