Bacterial Endocarditis

Bacterial endocarditis is an infection of either the heart valves or of the inner surface, called the endocardium, of the heart. Bacteria from the mouth, intestinal tract or urinary tract travel to the heart via the bloodstream. This bacteria doesn’t usually cause a problem in normal hearts. However, hearts that have defects, often even if the defects have been repaired, are vulnerable to infection. Once infection occurs, the bacteria continue to grow and may seriously damage the heart.

This infection can occur in any person (infant, child, or adult) who has heart disease present at birth (congenital heart disease), or can occur in people without heart disease. Bacterial endocarditis is most likely to occur in patients who have:

It is unlikely to occur in patients who have a completely repaired pulmonary valve stenosisatrial septal defectventricular septal defect or patent ductus arteriosus.

Bacteria can enter the body in many ways. Some of the most common ways include:

  • Dental procedures (including professional teeth cleaning)
  • Tonsillectomy or adenoidectomy
  • Examination of the respiratory passageways with an instrument known as a rigid bronchoscope
  • Certain types of surgery on the respiratory passageways, the gastrointestinal tract, or the urinary tract
  • Gallbladder or prostate surgery

Helping your child maintain excellent oral hygiene is an important step in preventing bacterial endocarditis. Regular visits to the dentist for professional cleaning and check-ups are essential. Proper oral hygiene is crucial, including regular brushing and flossing.

In order to prevent bacterial endocarditis, one dose of an antibiotic is given prior to procedures that put your child at risk. In most cases, the antibiotics can be given by mouth instead of through a shot or an intravenous (IV) line. Your child’s dentist, pediatrician, or cardiologist can give prescriptions for the antibiotics to you.

The usual signs of bacterial endocarditis are prolonged fever for two to three days in a person with congenital heart disease that occurs after a procedure in the mouth, intestinal tract or urinary tract. However, the infection may occur without a previous procedure. Symptoms may include:

  • Poor appetite
  • Fatigue
  • Joint pain
  • Rash
  • Weight loss

High dose antibiotics are administered by the intravenous route to maximize diffusion of antibiotic molecules into bacteria from the blood filling the chambers of the heart. This is necessary because neither the heart valves nor the bacteria adherent to them are supplied by blood vessels. Antibiotics are continued for a long time, typically two to six weeks.

Surgical replacement of the valve with a mechanical or bioprosthetic artificial heart valve is necessary in patients who fail to clear micro-organisms from their blood in response to antibiotic therapy, or in patients who develop cardiac failure resulting from destruction of a valve by infection.