What is Bacterial Endocarditis?
Bacterial endocarditis is an infection of the inner lining of the heart and the associated internal heart structures, such as the heart valves. 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 does not occur very often, but when it does, it can cause serious heart damage. It is very important to prevent this infection from happening, if possible.
Cause of Infection
Bacterial endocarditis occurs when bacteria (germs) enter the bloodstream and lodge inside the heart, where they can multiply and cause infection.
A normal heart has a smooth lining with normal valve structures, making it difficult for bacteria to stick to them. People with congenital heart disease may have abnormal inner heart linings due to thickened valves that cause abnormal opening or leaking of the valve. Even after surgery, roughened areas may remain due to scar tissue formation or surgical patches used to redirect blood flow. These rough areas inside the heart are ideal places for bacteria to build up and multiply.
How Bacteria Enters the Body
Bacteria can enter the body in many ways. According to the American Heart Association (AHA), some of the most common ways include the following:
- 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
- Chronic skin disorders, infections or burns
- Implanted cardiovascular medical devices
- Intravenous (IV) drug use
Risk Factors for Bacterial Endocarditis
Any infant, child or adult who has cyanotic congenital heart disease that has not yet been repaired can develop bacterial endocarditis. Some people who have already had a heart defect repaired may also need to take precautions against bacterial endocarditis for the rest of their lives, while others may no longer need to observe these precautions. According to the American Heart Association, heart problems that put children at risk for developing bacterial endocarditis include:
- Prosthetic (artificial) heart valves
- A previous history of endocarditis (even in the absence of other heart disease)
- Complex repaired or unrepaired cyanotic congenital heart disease (due to insufficient oxygen in the blood)
- Surgically constructed systemic pulmonary shunts or conduits with residual defects at the site or near the site of a prosthetic patch or device
- Cardiac transplantation recipients who develop acquired valve dysfunction, such as due to rheumatic heart disease or collagen vascular disease
Ask your child's physician about any questions you may have about risk factors.
Diagnosis of Bacterial Endocarditis
The doctor will review your child’s medical history and do a physical exam. They may also order the following tests:
- Echocardiogram (echo) - shows the structure and function of the heart by using sound waves to produce a moving picture of the heart and heart valves.
- Complete blood count (CBC) - measures the size, number and maturity of different blood cells in a specific volume of blood.
- Blood culture - identifies the specific type of bacteria in the bloodstream, if any.
Prevention of Bacterial Endocarditis
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.
Before your child has a procedure that may put them at risk (see Cause of Infection above), they’ll be given a dose of an antibiotic. In most cases, the antibiotics can be taken as a pill instead of through a shot or an intravenous (IV) line. Your child's dentist, pediatrician or cardiologist can provide an antibiotic prescription.
Treatment for Bacterial Endocarditis
Your child’s doctor will create a treatment plan based on:
- Your child's age, overall health, and medical history
- Extent of the infection
- Bacterial 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
Bacterial endocarditis is serious. This infection can cause severe damage to the inner lining of the heart and to the valves. The infection can be treated in most cases with strong antibiotics given through an IV over several weeks. However, heart damage may occur before the infection can be controlled. Consult your child's physician for more information.
