Bacterial Endocarditis in Children

Bacterial endocarditis is an infection of the inner lining of the heart (endocardium), or the heart valves. It doesn't occur in children very often. But when it does, it can cause serious heart damage.

Bacterial endocarditis occurs when bacteria in the blood enter the heart and cause infection of the heart.

Bacteria can enter the body in many ways. Having heart problems, especially with the valves, raises the chance that bacteria will affect the heart. Some of the most common ways bacteria get into the blood include:

• Dental work, such as professional teeth cleaning
• Surgery to remove the tonsils or adenoids
• Medical procedures, such as an exam of the airways with a bronchoscope
• Surgery, such as some respiratory, gastrointestinal, or urinary tract surgeries

Your child is at higher risk for bacterial endocarditis if they have:

• Artificial (prosthetic) heart valves
• Had endocarditis in the past
• Congenital (at birth) heart disease
• Had a heart transplant (immunocompromised), but the heart valves aren't working correctly
• Indwelling central venous catheter
• Rheumatic heart disease
• A weak immune system

Talk with your child's healthcare provider about your child's risk factors.

Symptoms can occur a bit differently in each child. They can include:

• Flu-like symptoms, such as fever, chills, tiredness, aching muscles and joints, night sweats, and headaches
• Shortness of breath
• Cough
• Skin changes, such as:
  • Pale skin
  • Bumps under the skin on the fingers and toes
  • Spots on the palms of the hands and soles of the feet
  • Small broken blood vessels with tiny spots under the nails, on the whites of the eyes, in the mouth, or on the chest
• Nausea and vomiting, decreased appetite, weight loss
• Discomfort in the belly
• Blood in the urine
• Swelling of the feet, legs, or abdomen

The healthcare provider will ask about your child’s symptoms and health history. They will give your child a physical exam and listen to your child's heart. Other tests may include:

• Echocardiogram (echo). This test looks at the structure of your child's heart and how well it's working. It uses sound waves to make a moving picture of the heart and heart valves. Your healthcare provider may be able to see a heart valve infection.
• Blood culture. This test looks for infection in your child's blood.
• Complete blood count (CBC). This test looks at all types of cells in your child's blood. These are red cells, white cells, and platelets.

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how bad the condition is.

A child heart specialist (pediatric cardiologist) and an infectious disease specialist will take care of your child. Treatment includes:

• Antibiotics. Antibiotics are usually given through the vein (IV) for several weeks. Your child will likely be in the hospital to get the medicine. Sometimes these antibiotics can be given at home with the help of a home-based healthcare team.
• Surgery. Some children may need heart valve surgery if there is severe heart valve damage due to the infection. This is done to fix or replace a damaged heart valve. Or a child may need surgery to help clean out the endocarditis. This may be done if the antibiotics don’t work well enough on the infection.

Complications of bacterial endocarditis include:

• Heart failure
• Blood clots or clumps of bacteria that travel to other parts of the body (emboli). This might travel to the arteries in the heart, brain, spleen, bowel, arms, or legs.
• Infection in other parts of the heart
• Weakened blood vessel (aneurysm), such as in the brain
• Kidney injury or disease
• Death

Bacterial endocarditis can't be entirely prevented. But some things can help. They include:

• Have your child take very good care of their teeth and gums
• Take your child to the dentist for regular cleaning and checkups
• Practice good hygiene
• Have your child take the full prescription of antibiotics when these are used to treat infections, such as strep throat

Some children with heart problems need to take antibiotics before some dental and medical procedures. Talk with your child's healthcare provider to find if your child needs antibiotics.

Your child will need ongoing care, including:

• Repeat echocardiograms and blood tests after the infection
• Regular health checkups
• Regular dental checkups
• Good daily oral hygiene (brushing and flossing)

Call your child's healthcare provider right away if your child has:

• Fever and chills
• Any of the symptoms of bacterial endocarditis or heart failure

• Bacterial endocarditis is an infection of the lining of the heart, including the valves.
• A child with heart problems is at higher risk of getting bacterial endocarditis.
• Symptoms are similar to the flu. Other symptoms include a cough, skin changes, and swelling in the arms, legs, or abdomen.
• Bacterial endocarditis is treated with antibiotics or surgery.
• If significant heart valve damage occurs, heart valve replacement surgery may be needed.
• Good dental care and body hygiene is an important part of preventing bacterial endocarditis.

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions, especially after office hours or on weekends.