Endocarditis infecciosa asociada a marcapasos: reporte de caso pediátrico

Abstract

INTRODUCTION: Infective endocarditis is a disease where the heart tissue or valves are infected by one or more microorganisms such as fungi or more commonly bacteria that are associated with the formation of vegetations and can cause damage to the heart structures. The estimated incidence of this pathology is 0.26% per 100,000 children, its mortality is extremely high and it is often associated with congenital heart conditions and the use of implantable devices. CLINICAL CASE: A 5-year-old male patient, with a history of single-chamber pacemaker placement 5 months prior to the consultation date, came to the emergency service due to a sudden onset clinical picture 7 days ago, characterized by quantified fever of 39.9 degrees Celsius, treated with amoxicillin plus clavulanic acid (dose 80mg/kg/day) and antipyretics without improvement. A transthoracic echocardiogram was performed where hyperechogenic lesions were evidenced near the pacemaker which was related to possible vegetations, so hospital admission was decided with a presumptive diagnosis of infective endocarditis. EVOLUTION: Multiple samples were taken for cultures and identification of the causal agent and positive results were obtained for methicillin-resistant Staphylococcus Hominis, in addition to the presence of a vegetation of approximately 6 mm in the pacemaker cable without size reduction despite antibiotic therapy in control echocardiograms, surgical resolution was decided by removing the pacemaker electrode and using extracorporeal circulation with successful outcome, in addition, a positive culture result was obtained for Candida guillermondi from the catheter tip, so antifungal treatment was added. CONCLUSION: It is important to recognize the predisposing risk factors for this pathology, and its multiple clinical manifestations, the correct taking of blood cultures and the early performance of echocardiography favor a timely diagnosis that allows a favorable prognosis, cardiac surgery in conjunction with pharmacological treatment achieve an effective result however they represent a high risk with considerable mortality.