Infective (Bacterial) Endocarditis (IE)

Infective endocarditis can affect any child, although it is uncommon. Children who have certain heart conditions tend to be at a higher risk for a bacterial infection in the heart valves or the inner lining (endocardium) of the heart. Infective endocarditis usually happens when bacteria from another part of the body enters the bloodstream and spreads to the heart where it attaches to damaged areas, such as a defective heart valve. Infective endocarditis can harm or destroy heart valves, causing serious damage to the heart. Children with infective endocarditis require prompt treatment from a pediatric cardiologist to protect the heart.

Wellness & Prevention

Infective endocarditis can start with something as routine as your child chewing food or brushing her teeth that allow bacteria to invade the bloodstream. Dental work, a medical procedure or an infection elsewhere in the body can also lead to infective endocarditis. The immune system normally kills bacteria that get into the bloodstream but a weakened immune system may not destroy the bacteria, which can pass through a healthy heart without causing an infection.

Your child may have a higher risk of developing infective endocarditis if he has specific congenital heart defects that haven’t been fully treated, an artificial heart valve, abnormal or damaged heart valve, recent heart surgery or previous endocarditis. The risk rises because diseased or damaged heart valves have a rougher surface than normal heart valves and provide bacteria with an optimal place to attach and reproduce. Heart valves aren’t directly supplied with blood, preventing white blood cells from reaching the valve to fight the infection.

Without treatment, the heart valves may be damaged or destroyed and stop work properly to move blood through the heart’s four chambers. Infective endocarditis can have life-threatening complications, such as heart failure, pockets of infected pus forming somewhere else in the body and stroke or organ damage caused by lumps of bacteria and cell fragments that left the heart.

Infective endocarditis can appear suddenly or slowly become noticeable. Each child may experience infective endocarditis differently but symptoms may include:

  • Fever, including a fever that comes and goes or repeated fevers higher than 104 degrees Fahrenheit
  • Fussing or crying that can’t be soothed
  • Fatigue
  • Chest pain
  • Shortness of breath
  • Bloody urine
  • Weight loss
  • Heart palpitations
  • Rash
  • Joint pain or arthritis
  • Muscle aches and pains

Diagnosis

Based on your child’s medical history and symptoms, your child’s cardiologist may suspect infective endocarditis. To confirm the diagnosis, he may perform different tests including:

  • Blood tests: A blood culture is an important tool used to detect and identify bacteria in the bloodstream. A pediatric cardiologist may also look for other conditions, such as anemia, that could be a sign of infective endocarditis.
  • Echocardiogram: Using sound waves, an echocardiogram produces a dynamic image of the heart and valves. An echocardiogram also evaluates the structure and function of the heart, including how blood flows and how valves are working. Your pediatric cardiologist may perform a transesophageal echocardiogram by guiding a probe down the throat to produce a more detailed image of your child’s heart.

Treatments

Pediatric cardiologists treat infective endocarditis with antibiotics. Your child may need high doses of antibiotics given through an IV line for two to six weeks. IV antibiotic treatment may be started at a medical center, then continued at home once your children begins to feel better. During treatment, your pediatric cardiologist may schedule frequent visits to ensure the antibiotics are working and periodic blood tests to see if the bacteria are still present.

Infective endocarditis that damages your child’s heart valves may require surgery to repair or replace the valve.

Aftercare

Following treatment for infective endocarditis, your pediatric cardiologist may prescribe antibiotics for your child to take before specific medical and dental procedures to help avoid a second infection. You can also help prevent infective endocarditis by teaching your child good oral hygiene habits, seeing a doctor if cut or sore in the skin doesn’t heal or the skin shows signs of an infection and avoiding things that could cause a skin infection, such as getting a tattoo or body piercing.