Zacherl S, Feyertag C, Salzer-Muhar U, Wimmer M
Abteilung für Pädiatrische Kardiologie der Universitätskinderklinik Wien.
Klin Padiatr. 1996 Mar-Apr;208(2):47-52. doi: 10.1055/s-2008-1043993.
Bacterial endocarditis in childhood is a rare but serious disease. The group of children with congenital heart disease at risk to develop bacterial endocarditis increases, because more children survive with advanced medical and surgical management. Rheumatic Fever as predisposing heart disease decreases and is of reduced importance.
From 1983 to 1993 16 patients in the age of 0.3 to 17.6 years (mean 10.6 years) were received by the Department of Pediatric Cardiology of the University Children's Hospital Vienna with the diagnosis "bacterial endocarditis". A congenital heart disease was known previously in 13 cases: 4 children had VSD, 2 children had Tetralogy of Fallot, 1 child had a single ventricle and an infundibular pulmonary stenosis, 4 children had pulmonary atresia, 1 child had a cleft of the mitral valve, and 1 child had a coronary artery fistula. Moreover, 1 child had a mitral valve prolapse with valvular regurgitation as a consequence of Marfan-Syndrome. 6 children with congenital heart disease had been treated surgically previously.
Medical data of all patients with the diagnosis of "bacterial endocarditis" between 1983 and 1993 were analysed. It was this period when echocardiography was used for the first time to contribute to diagnosis and course control.
In 11 of 16 cases positive blood cultures were obtained. Mostly Streptococcus viridans (4 cases) and Staphylococcus aureus (3 cases) were isolated. During the parenteral therapy with antibiotics 9 children suffered as a side effect from a drug induced fever and/or decreasing leucocytes and thrombocytes or a rash. In addition to the antibiotic therapy 8 children were treated surgically. One child died immediatly after the operation. 15 of the 16 patients with endocarditis survived.
With children with known heart disease the recommendations for the prevention of bacterial endocarditis have to be strictly followed and every long ongoing feverish disease has to be carefully examinated.
儿童细菌性心内膜炎是一种罕见但严重的疾病。由于先进的医疗和外科治疗使更多患有先天性心脏病的儿童存活下来，因此有患细菌性心内膜炎风险的儿童群体有所增加。作为易患心脏病的风湿热发病率降低且重要性下降。
1983年至1993年期间，维也纳大学儿童医院儿科心脏病科收治了16例年龄在0.3岁至17.6岁（平均10.6岁）之间诊断为“细菌性心内膜炎”的患者。13例患者先前已知患有先天性心脏病：4例儿童患有室间隔缺损，2例儿童患有法洛四联症，1例儿童患有单心室和漏斗部肺动脉狭窄，4例儿童患有肺动脉闭锁，1例儿童患有二尖瓣裂，1例儿童患有冠状动脉瘘。此外，1例儿童因马凡综合征导致二尖瓣脱垂伴瓣膜反流。6例患有先天性心脏病的儿童先前接受过手术治疗。
分析了1983年至1993年期间所有诊断为“细菌性心内膜炎”患者的医疗数据。正是在此期间首次使用超声心动图辅助诊断和病程控制。
16例患者中有11例血培养呈阳性。分离出的主要是草绿色链球菌（4例）和金黄色葡萄球菌（3例）。在抗生素静脉治疗期间，9例儿童出现药物性发热和/或白细胞及血小板减少或皮疹等副作用。除抗生素治疗外，8例儿童接受了手术治疗。1例儿童术后立即死亡。16例心内膜炎患者中有15例存活。
对于已知患有心脏病的儿童，必须严格遵循预防细菌性心内膜炎的建议，并且必须仔细检查每一例持续时间较长的发热性疾病。
