无心脏基础疾病的感染性心内膜炎患儿的临床特征分析

The Clinical Characteristics of Infectious Endocarditis in Children without Underlying Heart Diseases

目的本研究旨在探讨感染性心内膜炎(Infective endocarditis,IE)在无先天性心脏病(Congenitalheart disease,CHD)病史患儿中的临床表现。方法收集2008年1月～2011年12月间在我院住院治疗的IE伴或不伴CHD病史的小儿患者资料,并对临床和实验室数据进行回顾性分析。结果共纳入48例患者,其中31例患者伴CHD病史,17例不伴CHD病史(包括合并其他慢性疾病者或既往体健者)。在31例伴CHD病史的患儿中,仅22.6%存在牙科疾病史或皮肤/软组织感染史,而45.5%不伴CHD病史的患儿存在牙科疾病史或皮肤/软组织感染史。在6例无CHD病史的IE患儿中,5例因为中心静脉置管感染所致,其中耐甲氧西林金黄色葡萄球菌(MRSA)感染者2例,白色念珠菌感染者2例和凝固酶阴性葡萄球菌(CoNS)感染者1例;在11例既往健康患儿中,草绿色链球菌感染者3例,甲氧西林敏感的金黄色葡萄球菌(MSSA)2例,副流感嗜血杆菌感染者2例,肠球菌感染者1例,类白喉感染者1例。在17例无CHD病史的患儿中,5例致病菌为金黄色葡萄球菌(2个MRSA和3个MSSA)。IE从发病到诊断的平均间隔时间在CHD和既往体健患儿中分别为18d和31d。既往体健患儿的年龄相对偏大且往往需要外科手术去除感染病灶。结论近1/3的IE发生在既往无CHD病史的患儿中。IE在既往健康患儿中的发病机制尚不清楚,但既往皮肤感染或牙齿问题可能是潜在的风险因素。

Objective This study aimed to investigate the unique features of pediatric infective endocarditis （IE） patients without underlying heart diseases. Methods Pediatric patients who were admitted to our hospital from January 2008 to December 2011, with or without underlying heart diseases, were retrospectively analyzed. Clinical characteristics and laboratory data were collected. Results Forty-eight pediatric patients with IE were enrolled. Of these patients, 31 children（64.6 ~ ） had congenital heart disease（CHD）, six（ 12.5 ~ ） had non-CHD chronic disease, and eleven（22. 9~） were previously healthy adolescents. Five patients with non-CHD chronic conditions acquired infection from central catheter： two methicillin-resistant Staphylococcus aureus（MRSA）, two Candida albicans and one coagulase-negative Staphylococcus（CoNS）. The microbial pathogens in 11 previously healthy individuals were Streptococcus viridans （ n = 3 ）, methicillin-sensitive S. aureus （ MSSA, n ： 2 ）, Haemophilus parainfluenzae （ n = 2 ）, Enterococcus（n： 1） ,and Diphtheroid（n~ 1）. In total,five of 17 non-CHD patients were infected with S. aureus（two MRSA and three MSSA） . The average intervals between onset of symptoms and diagnosis of IE in the CHD and previously healthy groups was 18 and 31 days, respectively. Patients in the previously healthy group were older and more often required surgical interventions for removal of vegetation. Conclusion Over one-third（35.4%） of cases of IE in children occurred in patients without pre-existing cardiac diseases. The pathogenesis of IE in previously healthy individuals is still uncertain, but previous skin infection or dental problems may contribute to potential risk.