Infective endocarditis (IE)

What is infective endocarditis?

Infective endocarditis (IE) is a serious infection within the heart. This condition was previously known as subacute bacterial endocarditis or bacterial endocarditis.

IE is caused by germs such as bacteria and fungi. These germs may get into child's blood:

• from surgery
• through invasive medical procedures
• through very deep cuts or wounds
• from dental procedures

Usually, a child's body fights the germs, and they do not get sick. However, if the blood does not flow through your child's heart or valves smoothly, the bacteria or fungi can infect the heart and your child may get IE. It is more likely to occur in children with complex cyanotic heart disease, shunts, artificial heart valves and central venous catheters. In fact, fifty to seventy per cent of children who develop IE have congenital heart disease. The chance of your child getting IE is low. However, IE can be serious and may lead to damage to the heart or other organs in the body.

Signs and symptoms of infective endocarditis

Children with suspected IE may have:

• fever
• sweating
• loss of appetite
• pain in the muscles and joints, such as the knees, shoulders or knuckles
• weight loss
• rash caused by small, infected blood clots on the palms, soles or fingertips
• hemorrhages under fingernails caused by bleeding in small blood vessels
• headaches
• fatigue or weakness
• tea-coloured urine

What causes infective endocarditis?

Germs get into the bloodstream and lodge inside the heart. The germs can sometimes get into the blood after surgery or dental procedure.

Diagnosing infective endocarditis

There are several tests that can help the health-care team find out if your child has IE. These tests are:

• blood cultures to check for bacteria or fungi; your child will need to have several blood samples taken at different times
• urine and blood tests to check for signs of infection and to assess kidney function
• an echocardiogram, which is an ultrasound test of the heart to look for vegetation and to check how the heart is functioning

Treating infective endocarditis with antibiotics

If your child has IE caused by bacteria, they will need intravenous (IV) antibiotics. Similarly, IE caused by fungi require IV antifungal medication.

Your child may need IV medications for six weeks or longer. This treatment is started in hospital but can often be completed at home. For more serious cases, surgery may be needed.

Children with IE require close follow-up after discharge by a cardiologist to monitor their response to treatment.

Preventing infective endocarditis with three steps

It is much better and easier to prevent IE than to treat it. You can help protect your child from IE by taking these three simple steps:

1. Take good care of your child's teeth

Regular dental care and good oral hygiene help prevent tooth decay and reduce the risk of IE.

Take your child to the dentist for regular check-ups within six months of their first tooth or by the age of 12 months, whichever comes first.

2. Make sure your child takes antibiotics for any treatment that may cause them to get infective endocarditis

Some children with heart problems will always need to take antibiotics before getting treatments that could cause IE. Your child may need to take antibiotics before some dental procedures to prevent infective endocarditis. These dental procedures may include having a tooth taken out, teeth cleaning or fillings near the gums. Your child's cardiologist or nurse will tell you if your child needs antibiotics. If you are not sure if your child needs antibiotics, ask your child's health-care team.

3. Make sure infections of the skin or teeth that increase the risk of IE are treated promptly

How does infective endocarditis affect the heart and body?

The germs that get into the heart will grow to form an infected mass. This is called a “vegetation”. The vegetation can damage the part of the heart, block the flow of blood or pieces of vegetation can break away from the heart's surface and spread the infection to other parts of the body, like the lungs, blood vessels or bones. Small, infected blood clots can also spread to many small vessels in the body, including the brain, causing stroke. Individuals with IE can also develop kidney complications.

What are the long-term outcomes of infective endocarditis?

With early diagnosis and treatment, outcomes for children who develop infective endocarditis are generally positive. Left untreated, this infection can be fatal. Preventing it from occurring is the main goal.