School of Medicine, Faculty of Health and Life Science, University of Liverpool, Liverpool, UK.
Imperial College London, Exhibition Road, South Kensington, London, SW7 2BU, UK.
Eur J Pediatr. 2021 Oct;180(10):3089-3100. doi: 10.1007/s00431-021-04062-7. Epub 2021 Apr 14.
Infective endocarditis is very uncommon in children; however, when it does arise, it can lead to severe consequences. The biggest risk factor for paediatric infective endocarditis today is underlying congenital heart defects. The most common causative organisms are Staphylococcus aureus and the viridans group of streptococci. The spectrum of symptoms varies widely in children and this produces difficulty in the diagnosis of infective endocarditis. Infective endocarditis in children is reliant on the modified Duke criteria. The use of blood cultures remains the most effective microbiological test for pathogen identification. However, in blood culture-negative infective endocarditis, serology testing and IgG titres are more effective for diagnosis. Imaging techniques used include echocardiograms, computed tomography and positron emission tomography. Biomarkers utilised in diagnosis are C-reactive protein, with recent literature reviewing the use of interleukin-15 and C-C motif chemokine ligand for reliable risk prediction. The American Heart Association (AHA) and European Society of Cardiology (ESC) guidelines have been compared to describe the differences in the approach to infective endocarditis in children. Medical intervention involves the use of antimicrobial treatment and surgical interventions include the repair and replacement of cardiac valves. Quality of life is highly likely to improve from surgical intervention.Conclusion: Over the past decades, there have been great advancements in clinical practice to improve outcomes in patients with infective endocarditis. Nonetheless, further work is required to better investigative and manage such high risk cohort. What is Known: • The current diagnostic techniques including 'Duke's criteria' for paediatric infective endocarditis diagnosis • The current management guidelines utilised for paediatric infective endocarditis What is New: • The long-term outcomes of patients that underwent medical and surgical intervention • The quality of life of paediatric patients that underwent medical and surgical intervention.
感染性心内膜炎在儿童中非常罕见；然而，当它确实发生时，可能会导致严重的后果。当今儿童感染性心内膜炎最大的风险因素是潜在的先天性心脏缺陷。最常见的病原体是金黄色葡萄球菌和草绿色链球菌。儿童的症状谱差异很大，这给感染性心内膜炎的诊断带来了困难。儿童感染性心内膜炎依赖于改良的杜克标准。血液培养仍然是病原体鉴定最有效的微生物学检测方法。然而，在血培养阴性的感染性心内膜炎中，血清学检测和 IgG 滴度对诊断更有效。用于诊断的成像技术包括超声心动图、计算机断层扫描和正电子发射断层扫描。用于诊断的生物标志物包括 C 反应蛋白，最近的文献回顾了白细胞介素-15 和 C-C 基序趋化因子配体在可靠风险预测中的应用。美国心脏协会 (AHA) 和欧洲心脏病学会 (ESC) 指南进行了比较，以描述儿童感染性心内膜炎治疗方法的差异。医学干预包括使用抗菌治疗，手术干预包括心脏瓣膜的修复和置换。手术干预极有可能提高生活质量。结论：在过去几十年中，临床实践取得了重大进展，以改善感染性心内膜炎患者的预后。尽管如此，仍需要进一步的工作来更好地研究和管理这一高风险人群。已知：• 用于儿童感染性心内膜炎诊断的当前诊断技术，包括“杜克标准”• 用于儿童感染性心内膜炎的当前管理指南新内容：• 接受药物和手术干预的患者的长期结果• 接受药物和手术干预的儿科患者的生活质量。
