Infective endocarditis — branching viva

Branching viva from the febrile child with a new murmur and congenital heart disease, through the Modified Duke criteria and the culture-before-antibiotic discipline, the empirical and targeted antibiotic regimens, the surgical triggers of heart failure and abscess, to the neonate with staphylococcal bacteraemia and a central line whose right-sided endocarditis tests the principle of line removal.

branching clinical structured oral2 min readVerification in progress

Prompt

You are the paediatric registrar in the emergency department and the paediatric intensive care unit. The examiner asks you to assess three children: a nine-year-old with repaired tetralogy of Fallot, two weeks of fever and a new murmur; the same child on day four of therapy with a new atrioventricular block on the monitor; and a neonate in intensive care with Staphylococcus aureus bacteraemia and a central line. The examiner releases information in stages.

Stage 1 — The febrile child with congenital heart disease

Examiner: A nine-year-old girl with repaired tetralogy of Fallot presents with two weeks of low-grade fever, fatigue and anorexia. She has a new harsh diastolic murmur. Take me through your diagnostic approach. ^[1]

Expected thread: Recognise the risk substrate (congenital heart disease) and the cardinal sign (a new murmur). State that infective endocarditis is the leading diagnosis. Draw three sets of blood cultures from separate sites before any antibiotic, then request echocardiography, and apply the Modified Duke criteria. State the two major criteria (typical organism in two separate cultures; echocardiographic vegetation, abscess or new prosthetic dehiscence) and how the case becomes definite endocarditis. ^[3]

References5Show

[1]Baltimore RS; Gewitz M; Baddour LM; et al Infective Endocarditis in Childhood: 2015 Update: A Scientific Statement From the American Heart Association Circulation, 2015.PMID 26373317
[2]Baddour LM; Wilson WR; Bayer AS; et al Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association Circulation, 2015.PMID 26373316
[3]Li JS; Sexton DJ; Mick N; et al Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis Clin Infect Dis, 2000.PMID 10770721
[4]Pakotiprapha A; Chungsomprasong P; Vijarnsorn C; et al Risk of Infective Endocarditis in Pediatric Staphylococcal Bacteremia: A 20-Year Cohort Study Pediatr Infect Dis J, 2026.PMID 42115837
[5]Ondusko DS; Nolt D Staphylococcus aureus Pediatr Rev, 2018.PMID 29858291

Infective endocarditis — branching viva

branching clinical structured oral2 min readVerification in progress

Stage 1 — The febrile child with congenital heart disease

References5Show

[1]Baltimore RS; Gewitz M; Baddour LM; et al Infective Endocarditis in Childhood: 2015 Update: A Scientific Statement From the American Heart Association Circulation, 2015.PMID 26373317
[2]Baddour LM; Wilson WR; Bayer AS; et al Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association Circulation, 2015.PMID 26373316
[3]Li JS; Sexton DJ; Mick N; et al Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis Clin Infect Dis, 2000.PMID 10770721
[4]Pakotiprapha A; Chungsomprasong P; Vijarnsorn C; et al Risk of Infective Endocarditis in Pediatric Staphylococcal Bacteremia: A 20-Year Cohort Study Pediatr Infect Dis J, 2026.PMID 42115837
[5]Ondusko DS; Nolt D Staphylococcus aureus Pediatr Rev, 2018.PMID 29858291