Bacterial Endocarditis

This is wrote for parents but it is also the same advice for ADULT CHD’ers.

Bacterial Endocarditis (BE) is a life-threatening infection of the endothelium. This is the smooth surface of the inside parts of the heart, including the heart valves.

(BE occurs when germs enter your bloodstream, travel to your heart, and lodge on abnormal heart valves or damaged heart tissue. Abnormal growths (vegetations) that contain collections of bacteria may form in your heart at the site of the infection).

Although any child or adult can develop BE, it is very rare in people with healthy heart. People at greatest risk of BE have a damaged heart valve, an artificial heart valve or other heart defects. Hence, the risks of becoming infected depend on whether the heart condition has caused rough patches on what should be a smooth surface in the heart.

The cause of BE is some types of bacteria that get into the blood stream in very large numbers. These can then form strings, which can stick to the rough patches of the heart. Once there, BE can spread within the heart.

A rush of bacteria getting into the bloodstream is called ‘bacteraemia’. Cleaning your teeth and passing a motion cause bacteria to get into the blood stream, but in small numbers so the body’s immune system can destroy them.

A large number of the bacteria that cause BE can be found in infected mouths. So the easiest way for them to get into the bloodstream is if a dental instrument pierces the gums, for example.

BE can only happen if there is a rough patch in the heart for the bacteria to attach to. Rough patches are likely to occur where the blood is turbulent. For example, blood passing through a VSD at high pressure, could cause roughening to the lining of the valves in the right ventricle. Rough patches can also occur when there is a procedure carried out inside the heart, such as a switch operation for transposition of the great arteries. Areas of scarring, usually from surgery, can also be colonised by bacteria.

Causes

Bacteria are the cause of most cases, but fungi, viruses or other microorganisms also may be responsible.

Sometimes the culprit is one of many common bacteria that live in your mouth, upper respiratory tract or other parts of your body. In other cases, the offending organism may gain entry to your bloodstream through:

Certain dental or medical procedures. Dental procedures that cause bleeding may allow bacteria to enter your bloodstream. Bacteria may also be a concern with procedures done elsewhere in the body, such as in the respiratory tract.
An infection or other medical condition. Bacteria may spread from an infected area, such as a skin sore. Gum disease, a sexually transmitted disease or an intestinal disorder — such as inflammatory bowel disease — also may give bacteria the opportunity to enter your bloodstream.
Catheters or needles. Bacteria can enter your body through a catheter — a thin tube that doctors sometimes use to inject or remove fluid from the body. Contaminated needles and syringes are a concern for people who use intravenous (IV) drugs.

Common activities. Even everyday activities such as brushing your teeth or chewing food can allow bacteria to enter your bloodstream — especially if your teeth and gums are in poor condition.

Risks:

What is your child’s risk?

Preventing BE means taking a large dose of antibiotics before, or soon after, the bacteraemia occurs. This is called prophylactic use – that is, to prevent disease rather than treat it. Since having too many antibiotics can be bad for your child, you will only want to use them if he or she has:

  • rough patches on the lining of the heart, and
  • had his or her skin pierced when there is a danger of infection.

The child’s cardiologist is the best person to tell you if your child’s heart is going to be more susceptible to BE than a child without a heart condition. Generally this will be if she or he:

  • Has had BE before;
  • Has had a valve replacement;
  • Has an artificial shunt or conduit in the heart;
  • Has been born with a heart defect, other than a VSD, ASD, or PDA which has been judged to have closed successfully at follow-up;
  • Has hypertrophic cardiomyopathy;
  • has acquired valve damage.

Your child should NOT be at increased risk of BE because he or she:

  • Has a pacemaker or defibrillator;
  • Has arrhythmia such as SVT;
  • Has had acquired heart disease eg Kawasaki syndrome, which hasn’t damaged the valves;
  • Had a VSD, or ASD, or PDA that was successfully closed more than six months ago.

Symptoms:

You should suspect BE if your child has had dental treatment, or an infection recently and,

  • Is generally unwell, tired, inactive,
  • Has a temperature that has swung from high to normal over the last few days,
  • Has had shivering and sweating at night.

If your child is showing these symptoms you should contact your GP. You should remind the GP that your child is at risk of BE because of their heart condition and also ask for a blood test. If you feel the need for a diagnosis is urgent, contact the Cardiac Liaison Nurse (CLN) at your nearest Paediatric Cardiac Unit. The CLN should then arrange for a blood test to be taken, or arrange for you to see a cardiologist.

Diagnosis:

A blood test and echo will usually be enough to show if your child has BE or not.

Also, I found this information useful

In addition to a complete medical history and physical examination of your child, diagnostic procedures may include:

Echocardiogram (echo) – a procedure that evaluates the structure and function of the heart by using sound waves recorded on an electronic sensor that produce a moving picture of the heart and heart valves.
Complete blood count (CBC) – a measurement of size, number and maturity of different blood cells in a specific volume of blood.
Blood culture – a test that assesses for and determines the specific type of bacteria in the bloodstream, if any.

Treatment:

Treatment is usually long-term antibiotics given straight into a vein, and other drugs to help support your child through the infection, such as warfarin to prevent clots.

Specific treatment for BE will be determined by your child’s physician/Doctor based on;

  • Your child’s age, overall health, and medical history;
  • Extent of the infection;
  • Cause of the infection;
  • Your child’s tolerance for specific medications, procedures, or therapies;
  • Expectations for the course of the infection;
  • Your opinion or preference

BE is a life threatening disease and can cause severe damage to the inner lining of the heart and to the valves. Children and adults who survive it may have long-term effects such as valve replacements, brain damage, or even lost limbs. BE can be treated in most cases with strong antibiotics given through an IV over the course of several weeks. However, heart damage may occur before the infection can be controlled. Consult your child’s physician/doctor for more information.

So it is very important to help your child avoid BE.

Preventions:

Help to keep them free from other infections:

Dental Hygiene:

Take good care of your child’s teeth. Pay special attention to your child’s dental health. Brush and floss your child’s teeth and gums often, and schedule regular dental checkups.

If this is difficult for you, talk to your dentist about ways of lowering the risk of infection. Make sure that your child’s medical records show that he/she or you is susceptible to BE.

By avoiding body piercing/tattooing.
Piercing and tattooing carry high risk of infection, piercings on or around the mouth are very risky. Check with the cardiologist if ear piercing should be carried out with antibiotic cover.

THINGS TO DO: ALWAYS

Carry a BE card, you can obtain this from your child’s Specialist, your child’s support group, or British Heart Foundation.

Remember to arrange the antibiotic for your child at the right time before the appointment for treatment.

For Americans:

If you’re at risk of BE, let all of your health care providers know. You may want to request an endocarditis wallet card from the your Specialist at your

Specialist Centre (For Amerian’s; American Heart Association. Check with your local chapter or print the card from the association’s Web site).

***********NOTE: UPDATE 2007************************************

New guidelines released in 2007 reserve preventive treatment only for those people who would have the worst outcomes if they get infective BE. And, the list of procedures before which antibiotics are recommended has grown shorter. Antibiotics are now recommended only before the following:

Certain dental procedures (those that manipulate gum tissue or part of the teeth)

Procedures involving the respiratory tract, infected skin or musculoskeletal tissue

Antibiotics are no longer recommended before all dental procedures or for procedures of the urinary tract or gastrointestinal system.

If you have been told to take antibiotics before any of these procedures in the past, check with your doctor to see if that recommendation has changed.

Related Links:

I acquired the information to write this article from various sources, here are some example of places that I looked at:

http://www.childrens-heart-fed.co.uk/index.cfm
http://www.mayoclinic.com/health/endocarditis/DS00409/DSECTION=3
http://www.chop.edu/consumer/your_child/condition_section_index.jsp?id=-9339