infective endocarditis in children of southern iran

infective endocarditis is an uncommon heart disease with a variable incidence, mostly related to the ever-increasing development of cardiac surgery and the longer survival of patients with congenital heart disease (chd). thirty-seven episodes of infective endocarditis (ie) were evaluated in 36 children (under 15 years of age) admitted to hospitals affiliated to shiraz university of medical sciences during a 10 year period. the mean age was 9.2 years, only one boy was under one year of age and 6 of the children were under 5. overall, the male to female ratio was 1.46/1, but the ratio was equal in children under 5 years. the frequency of ie was 3 per 1000 pediatric admissions. chd was the most common underlying disease (27 patients, 73.0%), followed by rheumatic heart disease (rhd) (7 patients, 18.9%). ventricular septal defect was the most common acyanotic chd and tetralogy of fallot was the most common cyanotic chd. blood cultures were positive in 54% and vegetations were present in 57.5% by 2-dimensional echocardiography. streptococcus species (mostly viridans) was the most common infecting micro-organism. the most common site of vegetation was the pulmonary valve, followed by the aortic valve. there were 6 deaths (16.2%) due to different causes. mortality occurred mostly in culture negatives or in those infected by gram-negative micro-organisms (p<0.0 1). all mortalities had left-sided vegetations (p<0.001). in conclusion, despite medical and surgical advances, this fatal complication of heart disease remains a significant medical problem. an effective chemoprophylaxis strategy for rheumatic fever and ie will decrease the incidence and outcome of this potentially serious illness.