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Hjartaþelsbólga í íslenskum börnum

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Authors
Þorsteinn Gunnarsson
Hróðmar Helgason
Issue Date
1994-11-01

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Other Titles
Infective endocarditis in Icelandic children
Citation
Læknablaðið 1994, 80(9):442-3, 445-6
Abstract
The aim of this study was to investigate the predisposing conditions and etiology of infective endocarditis (IE) in Icelandic children during the last ten years from 1984 to 1993. Records from all cases of IE in Iceland during this period were sampled. Vegetations were confirmed in all patients by echocardiography and in cases of culture negative IE the diagnosis was made on clinical grounds and on the response to antibiotic treatment. During this period eight children were diagnosed with IE. Five of these cases occurred in a cluster during a two months period last year (1993). Four patients had a known heart defect, three had a central venous catheter (CVC) and one patient had no factors known to predispose IE. The most common site of infection was the tricuspid valve seen in six cases, one in the aortic valve and one in the aortic arch. All patients survived without neurological sequel. A positive blood culture was obtained in six cases. The infective organisms were Staphylococcus aureus (three patients), Staphylococcus epidermitis (one patient), Streptococcus sanguis (one patient) and Candida albicans (one patient). The results show that the spectrum of IE in Icelandic children is similar to the changing spectrum elsewhere where infected CVC's are now responsible for relatively high proportion of the cases. This is most likely due to greater use of CVC's especially in neonatal intensive care units. A relatively few cases of typical IE, i.e. in children with an underlying heart lesion or following cardiac surgery, suggests effective prophylactic therapy and follow up.
Tilgangur rannsóknarinnar var að kanna áhættuþætti og orsakir hjartaþelsbólgu í íslenskum börnum og afdrif þeirra barna sem fengu sjúkdóminn á 10 ára tímabili (1984-1993). Gögnum um öll börn sem fengið höfðu hjartaþelsbólgu á Íslandi á umræddum tíma var safnað og þau yfirfarin. Sýkingardrönglar sáust í öllum sjúklingunum við ómskoðun af hjarta. Sjúkdómsgreiningin var byggð á klínísku mati ásamt svari við sýklalyfjameðferð þegar um neikvæða blóðræktun var að ræða. Á þessu tímabili greindust átta börn með hjartaþelsbólgu. Fimm þeirra greindust á árinu 1993. Helmingur sjúklinganna var með meðfæddan hjartagalla. Hinir voru með eðlilegt hjarta en þrír þeirra vora með miðlægan bláæðalegg (central venous catheter, CVC). Einn sjúklingur var ekki með neina bekkta áhættuþætti sem taldir eru leiða til hjartaþelsbólgu í börnum. Sýkingarstaðir voru þríblöðkulokan (sex sjúklingar), ósæðarlokan (einn sjúklingur) og ósæðarboginn (einn sjúklingur). Sýklar ræktuðust frá sex sjúklingum. Þeir voru Staphylococcus aureus (þrír sjúklingar), Staphylococcus epidermitis (einri sjúklingur), Streptococcus sanguis (einn sjúklingur) og Candida albicans (einn sjúklingur). Allir sjúklingarnir eru lifandi og sluppu allir við miðtaugakerfisskaða. Niðurstöðurnar sýna að orsakir hjartaþelsbólgu í íslenskum börnum á síðasta 10 ára tímabili eru í samræmi við það sem er að gerast erlendis þar sem stærri hluti sjúklinganna er nú með eðlilegt hjarta og miðlægan bláæðalegg. Þær sýna einnig lágt hlutfall dæmigerðrar hjartaþelsbólgu í börnum sem hafa hjartagalla. Má eflaust þakka það góðu eftirliti og virkri fyrirbyggjandi meðferð.
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