PEDIA - Acquired Heart Disease

PEDIATRICS

Acquired heart disease

MARIVIC MOTILLA-ESGUERRA, MD Bacterial Agents in Pediatric Infective Endocarditis

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(" T# $%#& the eti#)#*+ #' acquired heart diseases " ."

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COMMON: NATIVE VALVE OR OTHER CARIAC LE!ION! • • •

Virida%s *r#u stret#c#cci 0S"/uta%s, S" sa%*uis, S" /itis1 Stah+)#c#ccus aureus Gr#u D stret#c#ccus 0e%ter#c#ccus1 0S"b#is, S" 'aeca)is1

CHD vs. normal heart  I%'ectie E%d#carditis •

a /icr#bia) i%'ecti#% #' the e%d#cardia) 0e%d#the)ia)1 sur'ace #' the heart" 2atie #r r#sthetic heart a)es E%d#carditis a)s# ca% i%#)e seta) de'ects The /ura) e%d#cardiu/ I%traascu)ar '#rei*% deices i%tracardiac atches sur*ica))+ c#%structed shu%ts  i%trae%#us catheters"  –  –  –  –

"NCOMMON: NATIVE VALVE OR OTHER CARIAC LE!ION! • • • •

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Stret#c#ccus %eu/#%iae 3ae/#hi)us i%')ue%4ae C#a*u)ase-%e*atie stah+)#c#cci C#5ie))a bur%etii 06 'eer1 2eisseria *#%#rrh#eae 7ruce))a Ch)a/+dia sittac)i Ch)a/+dia trach#/atis Ch)a/+dia %eu/#%iae Le*i%e))a 7art#%e))a 3ACE8 *r#u Stret#baci))us /#%i)i'#r/is Pasteure))a /u)t#cida Ca/+)#bacter 'etus

Cu)ture %e*atie 09: #' cases1 PRO!THETIC VALVE VALVE • • • • • • • •

Microorganisms

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Stah+)#c#ccus eider/idis Stah+)#c#ccus aureus Virida%s *r#u stret#c#ccus Pseud#/#%as aeru*i%#sa Serratia /arcesce%s Dihther#ids Le*i#%e))a secies;= ?u%*i;@=

Pre-existing congenital/acquired heart disease Pressure gradient – turbulence

tissue damage

fibrin / platelet adherence

TRA2SCOM  7EDIMA2S MD!

PEDIATRICS

Acquired heart disease

lysosomal granules release hydrolytic enymes !aboratory Diagnosis Clinical and La#orator$ %indings in Patients &it' IE

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7)##d Cu)ture  /#st a)uab)e t##)

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C#))ecti#% #' ( #r  sa/)es #er a (. hr eri#d is adequate

C)i%ica)

i% /#st cases ?i%di%*

?eer 2#%-seci'ic s+/t#/s 0/+a)*ia,

?reque%c+ BBBB BBB

arthra)*ia, headache, /a)aise1 3eart /ur/ur 0%e& #r cha%*i%*1

BB

3eart ?ai)ure

BB

Petechiae E/b#)ic he%#/e%a S)e%#/e*a)+ 2eur#)#*ic ?i%di%*s

BB BB BB BB

Os)er %#des, a%e&a+ )esi#%s,

B

R#th s#ts, s)i%ter he/#rrha*es !egend"

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Acute hase reacta%ts are e)eated

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ESR  #%)+ /i%i/a))+ e)eated 0as the disease r#*resses , the ESR &i)) i%crease1 - re/ai% e)eated '#r s#/e ti/e ee% a'ter d#cu/e%ted bacteri#)#*ic cure

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I//u%e c#/)e5es #r Rheu/at#id 'act#r

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A%e/ia  c#//#%, articu)ar)+ i% )#%* sta%di%* i%'ecti#%

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Ma+ be he/#)+tic #r /a+ rerese%t a%e/ia #' chr#%ic disease

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Micr#sc#ic #r /acr#sc#ic he/aturia rerese%ts re%a) e/b#)i4ati#% #r %ehritis

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Leu$#c+t#sis  is %#t a c#%siste%t 'i%di%* but is /#re c#//#% i% acute IE

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####

very common

## infrequent 

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in most cases

# rare

A%tib#dies a*ai%st tech#ic acid a%d ce)) &a)) etid#*)+ca% i% seere stah+)#c#cca) i%'ecti#% /a+ be rese%t

&D-'chocardiography  La#orator$ •

A %e*atie ech#cardi#*ra/ d#es %#t ru)e #ut e%d#carditis

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M#re he)'u) i% chi)dre% &ith %#r/a) cardiac a%at#/+ #r

?i%di%*

?reque%c+

P#sitie b)##d cu)ture 0#'' a%tibi#tics1

BBBB

 E)eated acute hase reacta%ts

BBBB

A%e/ia

BBB

e*etati#%, a% a%%u)ar abscess, r#sthetic a)e artia)

3e/aturia

BBB

dehisce%ce, a%d %e& a)u)ar re*ur*itati#%

&ith is#)ated a)ar ab%#r/a)ities i% chi)dre% &ith /#re c#/)e5 c#%*e%ita) a%#/a)ies

Prese%ce #' rheu/at#id 'act#r

BB

Leu$#c+t#sis

BB

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Du$e Maj#r Criteria F #sci))ati%* i%tracardiac /ass #r

DIAG2OSISF Du(e criteria

)a*or"

!egend" ####

very commom

###

in most cases

##

$nfrequent

#

rare

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0B1 b)##d cu)ture

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Eide%ce #' e%d#carditis #% ech#cardi#*rah+

A" Positive echocardiogram '#r IE de'i%ed asF i" +scillating intracardiac mass #% valve #r supporting

structures, i% the ath #' re*ur*ita%t jets, #r a% i/)a%ted Clinical %eatures •

2e& #r cha%*i%* /ur/urs are usua))+ heard - ?reque%t auscu)tati#% is esse%tia)

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Patie%ts &ith susected e/b#)ic ee%ts are ca%didates '#r

material  i% the abse%ce #' a% a)ter%atie a%at#/ic e5)a%ati#% #r ii" ,bscess, #r iii"e partial dehiscence of prosthetic valve #r 7" e valvular regurgitation 0&#rse%i%* #r cha%*i%* #' ree5isti%* /ur/ur1

seria) ech# t# )#ca)i4e e*etati#%s a%d t# de'i%e cha%*es that

Minor criteria

/a+ #ccur &ith ti/e

Predisposition" predisposing heart condition or intravenous drug use

S)e%#/e*a)+ /a+ be rese%t i% a /aj#rit+ #' i%sta%ces

%ever" temperature  01.23 C 4522.63 %7

&he% the disease has bee% rese%t '#r &ee$s #r /#%ths

8ascular phenomena" ma*or arterial emboli9 septic pulmonary

2eur#)#*ic 'i%di%*s are rese%t i% (: #' chi)dre% a%d /a+

infarcts9 mycotic aneurysm9 intracranial hemorrhage9 con*unctival

si/u)ate the icture #' a% abscess, i%'arct #r asetic

hemorrhages9 and :aneay lesions. $mmunologic phenomena"

/e%i%*itis

glomerulonephritis9 +sler;s nodes9