Endocardite infectieuse sur communication interventriculaire: intérêt de l’échocardiographie? de l’antibioprophylaxie ?

Abstract

L’endocardite infectieuse peut survenir sur un cœur sain ou pathologique. Parmi les cardiopathies à risque, on trouve les cardiopathies congénitales dont la CIV est la plus fréquente. Nous rapportons le cas d’une endocardite infectieuse à streptocoque oral, survenue sur une CIV non connue jusqu’à maintenant, chez un patient de 17 ans, se présentant sous forme de fièvre prolongée associée à une éruption cutanée. L’examen de la sphère ORL révéla par ailleurs des angines pseudomembraneuses avec un mauvais état buccodentaire. Les EI sur CIV sont les plus fréquentes des EI sur cardiopathie congénitale. Leur présentation clinique peut être atypique d’où le rôle primordial de l’échocardiographie. La prévention dans ces cas passe par une hygiène bucco-dentaire et cutanée optimale et non par une antibioprophylaxie.

Diagnosis and Management of Infective Endocarditis in Patient with Ventricular Septal Defect: A Report of Clinical Case from Dakar, Senegal

“…It is known that VSD is the most common malformation. Some studies found that patients with VSD were six times more likely to suffer from IE compared to the general population [1,6]. TTE or TEE are useful for diagnosis and follow-up of IE [7,2].…”

“…Like our patient, the treatment of IE in case of positive blood culture is primarily based on a targeted antibiotic therapy in monotherapy or in combination. Practically, the intravenous route should be considered as the reference because it ensures total bioavailability [1]. During antibiotic treatment, disappearance of fever and the remaining normal temperature, negative blood culture and disappearance of biological inflammation syndrome are the best guarantee of the efficiency of antibiotic therapy.…”

“…The definitive answer requires controlled randomized studies which is tricky due to the large number of patients to include. In our opinion, it is reasonable to apply the recommendations of international societies but in taking into consideration the socio-economic context, the expertise in dentistry but also the microbiological environment of each region; the antibiotic prophylaxis in case of VSD is not necessary [11,1].…”

“…Infective Endocarditis (IE) is an infective inflammation of the endocardium leading mainly to valvular damage and causing significant mortality and morbidity. It can occur on healthy or pathological heart [1]. Endocarditis due to Streptococcus pneumoniae is unusual in children, accounting for 3%-7% of all cases of childhood endocarditis.…”