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Images in Paediatrics
Diagnosis of infective endocarditis using focused cardiac ultrasound
Diagnóstico de endocarditis infecciosa mediante ecografía cardíaca dirigida
Verónica Jiménez Escobara,
Corresponding author
vjescobar@riojasalud.es

Corresponding author.
, Cristina Walter Carinb, Irene Antoñanzas Torresc, Daniel Palanca Ariasd
a Servicio de Pediatría, Hospital San Pedro, Logroño, La Rioja, Spain
b Unidad de Cardiología Pediátrica, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
c Servicio de Pediatría, Hospital Infantil Universitario Miguel Servet, Zaragoza, Spain
d Unidad de Cardiología Pediátrica, Unidad de Cuidados Intensivos Pediátricos, Servicio de Pediatría, Hospital Infantil Universitario Miguel Servet, Zaragoza, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Focused cardiac ultrasound &#40;FoCUS&#41; is the term used to refer to point-of-care ultrasound &#40;PoCUS&#41; applied to the evaluation of the haemodynamically unstable patient&#46; Its growing application in paediatric care can allow early diagnosis&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of an infant aged 13 months with fever without a source&#44; a previous history of hand&#44; foot and mouth disease &#40;HFMD&#41; and bacteraemia &#40;<span class="elsevierStyleItalic">Kingella kingae</span>&#41;&#46; On day 4&#44; after targeted antibiotherapy&#44; the fever&#44; tachycardia&#44; tachypnoea and systolic murmur persisted&#44; prompting performance of FoCUS in the paediatric ward&#44; the chief findings of which were a vegetation &#40;Appendix B&#44; video 1&#41; and mitral valve insufficiency&#44; confirmed by the on-call cardiologist &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1&#8211;3</a>&#41;&#46; The patient was transferred to a hospital that had a paediatric intensive care unit &#40;PICU&#41; where he remained respiratory stable &#40;nasal prongs&#41; and&#44; due to the clinical and sonographic signs of heart failure&#44; received haemodynamic support &#40;milrinone and diuretics&#41;&#46; The blood test results were unremarkable&#44; with the most salient being the level of pro B-type natriuretic peptide &#40;proBNP&#44; 5039&#8239;pg&#47;mL&#41;&#46; The patient required mitral valve repair and placement of a mechanical prosthetic valve in a second surgical intervention on account of progressing haemodynamic instability&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Endocarditis caused by HACEK group bacteria is infrequent and associated with a high incidence of complications&#44; and early diagnosis and treatment are crucial&#46; In children&#44; <span class="elsevierStyleItalic">K kingae</span> is part of the normal oropharyngeal microbiota and it rarely causes invasive infection&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The previous episode of HFMD may have facilitated its passage into the bloodstream&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Although the most recent PoCUS guidelines<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> have found that the evidence on its used for diagnosis of endocarditis is contradictory and of poor quality&#44; it can detect intracardiac masses&#44; allowing referral of the patient to a paediatric or intensive care cardiologist with advanced skills in the technique&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The use of point-of-care FoCUS allowed early optimization of the diagnostic and therapeutic approach&#46;</p></span>"
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ISSN: 23412879
Original language: English
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Anales de Pediatría (English Edition)