Pediatric Infective Endocarditis and Stroke: A 13-Year Single-Center Review

Pediatr Neurol. 2019 Jan:90:56-60. doi: 10.1016/j.pediatrneurol.2018.07.001. Epub 2018 Oct 17.


Objective: We explored the relationship between pediatric infective endocarditis and stroke.

Patients and methods: All children encountered with infective endocarditis from January 2002 to December 2015 were included as our sample, and their medical records were comprehensively reviewed.

Results: Sixty children with infective endocarditis were identified, including 30 boys and 30 girls aged eight months to 18 years (mean ± SD: 10.3 ± 5.6), and om 43 (71.6%) of these individuals had congenital heart disease. Left-sided endocarditis occurred in 25 patients (41.7%), and vegetations were found in 58 individuals (96.6%). The most often encountered microorganisms were Streptococcus viridans and Staphylococcus aureus, which were identified in five and four patients, respectively. Postendocarditis stroke occurred in nine patients, including five with cerebral infarction, two with intracerebral hemorrhage, and one with subarachnoid hemorrhage. The remaining child experienced cerebral infarction, intracerebral hemorrhage and subarachnoid hemorrhage simultaneously. The incidence of stroke in children with left-sided endocarditis was significantly higher than that of which in those who had right-sided endocarditis (32% versus 2.8%, P < 0.01). The most common manifestation of stroke was hemiparesis (55.5%). Two girls died of stroke, and the mortality rate in the patients who had stroke was significantly higher than that in those without stroke (22.2 % versus 3.9 %, P < 0.05).

Conclusions: Our data indicate that stroke is common among children with infective endocarditis, especially in those with left-sided endocarditis, and major stroke may increase their risk of death. Congenital heart disease is the main underlying disease in children with infective endocarditis in China.

Keywords: Cerebral embolism; Chinese children; Congenital heart diseases; Infective endocarditis; Stroke.

MeSH terms

  • Adolescent
  • Cerebral Hemorrhage / diagnostic imaging
  • Cerebral Hemorrhage / etiology*
  • Child
  • Child, Preschool
  • Echocardiography
  • Endocarditis, Bacterial / complications*
  • Endocarditis, Bacterial / diagnostic imaging
  • Female
  • Humans
  • Infant
  • Male
  • Paresis / etiology
  • Retrospective Studies
  • Risk Factors
  • Staphylococcal Infections / complications*
  • Staphylococcal Infections / diagnostic imaging
  • Staphylococcus aureus / isolation & purification
  • Streptococcal Infections / complications*
  • Streptococcal Infections / diagnostic imaging
  • Stroke / diagnostic imaging
  • Stroke / etiology*
  • Viridans Streptococci / isolation & purification