Symposium: cardiovascular medicineInfective endocarditis in children

Infective endocarditis is a result of infection of the endocardium, particularly of the heart valves. The most common causative organisms in children are Streptococci, Staphylococci and Enterococci. The classical signs of infective endocarditis like Roth spots, Janeway lesions, splinter haemorrhages and Osler's nodes are rare in children. A high index of suspicion in children at risk of endocarditis or in any febrile child with a new murmur is the key to early diagnosis. Detailed history, meticulous examination, repeated blood cultures, and echocardiography are essential in establishing the diagnosis. The management of infective endocarditis involves a prolonged course of antibiotics for at least 4-6 weeks. Prophylactic antibiotics prior to dental and other medical procedures are no longer recommended in the UK. The emphasis should be on educating families in early recognition of symptoms that may indicate infective endocarditis and when to seek expert advice, especially in children at high risk of developing endocarditis. Historically, rheumatic heart disease accounted for most cases of endocarditis in children, however, recently children with congenital heart defects contribute to a large proportion of infective endocarditis cases, especially in the developed world. This review explains which children are at risk, how to establish a diagnosis and when and how to treat.