The concept of infective endocarditis in children
Infective endocarditis is more often in childrensecondary, and in most cases it develops on the background of congenital heart defects - with tetralogy of Fallot, ventricular septal defect, aortic stenosis. Primary endocarditis is rare.
In children, the first 2 years of life can developnatal, congenital and acquired endocarditis. Congenital endocarditis in most cases occur in the presence of viral and bacterial infections in the mother. Not a few are important acquired endocarditis in infants with intact heart valves. During outbreaks of respiratory viral infections seen in children cases tromboendokarditov first months of life. a separate group of infective endocarditis in children is the so-called prosthetic valve endocarditis, proceeding according to the type of acute sepsis. Endocarditis can be repeated and developed in previously cured patients. The conditions for the occurrence of endocarditis are repeated parenteral administration of drugs, surgical procedures, the presence of foci of infection.
The main manifestations of the disease
The main manifestations of infective endocarditischildren largely opredelyutsya varintami the disease. current options are reduced to acute, chronic, and abortive. Subacute endocarditis is characterized by slow, gradual onset with no clear symptoms. To this group belongs endocarditis in the outcome of acute illness when it is more than 6 weeks duration. As in adults, acute endocarditis is usually primary, and subacute usually complicated congenital heart disease.
Typical manifestations of the disease areconstant fever, chills, sweating attacks when the temperature drops. Intoxication appears pale, pale gray, or earthy color, often in combination with jaundice associated with the development of toxic-allergic (especially long-term use of large doses of antibiotics) or septic hepatitis. The skin may show various lesions located in the area of the collarbone, back, conjunctiva, soft and hard palate. In all cases, bacterial endocarditis detected in children uvelichiny spleen. Infective endocarditis can be accompanied by pneumonia, transient loss of consciousness, abdominal pain or back pain due to the development of thromboembolic events.
The symptoms of heart disease are an important,sometimes the greater part of the manifestations of septic endocarditis. There may be more likely to moderate pain in the heart, but sometimes the pain can be intense wear. Most symptoms go away after taking antibiotics.
Active bacterial endocarditis in children
Active sepsis in children adopteddivided into three levels. High activity (III degree) is characterized by fever, chills, profuse sweating, a sharp increase in ESR. With moderate activity (II degree) all of the above symptoms are less pronounced, and with minimal activity (I degree) body temperature close to normal, the child's well-being little changed, but some of the clinical manifestations and laboratory data indicate the current disease.
Treatment of the disease
Treatment of infective endocarditis in childrenbased on the use of antibiotics. Antibiotics (preferably bactericidal activity) administered in high doses. In the treatment using penicillin, oxacillin, ampicillin, carbenicillin, cephalosporins and aminoglycosides. Depending on the type of pathogen and the effectiveness of therapy using various combinations of antibiotics. With acute circulatory failure occurred are shown with bed rest, fluid restriction, salt, diuretics.
When concomitant myocarditis, nephritis,arthritis treatment added NSAIDs, or (for health) glucocorticoid dose not exceeding 0.5 mg per 1 kg of body weight per day. In cases of staphylococcal endocarditis shows the transfusion of plasma antistaphylococcal, staphylococcal toxoid antiphagin, autovaccine. When transfused packed red blood cells anemia, while in children with congenital heart disease hemoglobin should be maintained at a higher level of 150-160 g / l).