Bacterial Endocarditis in Children

Bacterial endocarditis is an infection of the lining of the heart (endocardium), and the heart valves. It does not happen 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.

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 he or she has:

• Artificial (prosthetic) heart valves
• Had endocarditis in the past
• Congenital heart disease
• Had a heart transplant, but the heart valves aren't working properly

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. He or she 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 is working. It uses sound waves to make a moving picture of the heart and heart valves. Your healthcare provider may be able to show a heart valve infection.
• 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.
• Blood culture. This test looks for infection in your child's blood.

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe 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 (intravenous or IV) for several weeks. Your child will likely be in the hospital to get the medicine.
• Surgery. Some children need valve replacement surgery if there is severe heart valve damage or if the infection can't be cleared due to an abscess.

Complications of bacterial endocarditis include:

• Heart failure
• Blood clots or clumps of bacteria that travel to other parts of the body (emboli). This might be 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
• Death

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

• Making sure your child takes very good care of his or her teeth and gums
• Taking your child to the dentist for regular cleaning and checkups
• Practicing good hygiene

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. This means 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

• 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.
• 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 child’s healthcare provider:

• Know the reason for the visit and what you want to happen.
• Before your visit, write down questions you want answered.
• 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 for your child.
• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
• Ask if your child’s 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 your child does not take the medicine or have the test or procedure.
• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.