No pathologic evidence of endocarditis at surgery or autopsy after antibiotic therapy of >4 days or does not meet criteria for possible endocarditis
Adapted from Tissieres P, Gervaix A, Beghetti M, et al: Value and limitations of the van Reyn, Duke, and modified Duke criteria for the diagnosis of infective endocarditis in children, Pediatrics 112: e467−e471, 2003.
ring, or myocardial abscess. These complications should be monitored by physical examination and echocardiography. Cerebral abscesses or aneurysms can cause a stroke-like picture. Splenic abscesses can cause fatal bleeding.
The outcome of infective endocarditis caused by the most common organisms is often good. The cure rate is greater than 90% in uncomplicated endocarditis caused by viridans streptococci on a natural valve, 75% to 90% for Enterococcus endocarditis treated by a synergistic combination of antibiotics, and 60% to 75% for S. aureus endocarditis with an acute, severe presentation. The prognosis for endocarditis caused by gram-negative bacilli and rarer organisms is poor. Fungal endocarditis has the poorest prognosis, with a cure rate of about 50% even with valve replacement.
In high-risk patients, prophylactic antibiotics are required before and during all dental procedures that involve manipulation of gingival tissue or the periapical region as well as invasive procedures of the respiratory tract, infected skin, or muscle. In most cases, oral amoxicillin 50 mg/kg (maximum dose, 2 g) taken 30 to 60 minutes before the procedure is the recommended regimen. Clindamycin or azithromycin are alternative regimens indicated for most patients allergic to β-lactams. Prolonged or continuous antibiotic prophylaxis is not recommended.
Acute enteritis or acute gastroenteritis refers to diarrhea, which is abnormally frequent, and liquidity of fecal discharges. Diarrhea is caused by different infectious or inflammatory processes in the intestine that directly affect enterocyte secretory and absorptive functions. Enteritis has many viral, bacterial, and parasitic causes (Table 112-1). Some of these processes act by increasing cyclic adenosine monophosphate levels (Vibrio cholerae, Escherichia coli heat-labile toxin). Other processes (Shigella toxin) cause secretory diarrhea by affecting ion channels or by unknown mechanisms (Table 112-2).
Diarrhea is a leading cause of morbidity and a common disease in children in the United States. In the developing world, it is a major cause of childhood fatality. The epidemiology of gastroenteritis depends on the specific organisms. Some organisms are spread person to person, others are spread via contaminated food or water, and some are spread from animal to human. Many organisms spread by multiple routes. The ability of an organism to infect relates to the mode of spread, ability to colonize the gastrointestinal tract, and minimum number of organisms required to cause disease.
Viral causes of gastroenteritis in children include rotaviruses, caliciviruses (including the noroviruses), astroviruses,and enteric adenoviruses (serotypes 40 and 41). Rotavirus is the most frequent cause of diarrhea during the wintermonths. Vomiting may last 3 to 4 days, and diarrhea maylast 7 to 10 days. Dehydration is common in younger children. Primary infection with rotavirus may cause moderate to severe disease in infancy but is less severe later in life. Thisillness is much less common in areas where infants receive the rotavirus vaccine.