Endocarditis means infection of the lining of the heart. It is a rare condition, limited for practical purposes to children with a predisposing malformation of the heart or its valves that causes turbulent blood flow.

A particular inhabitant of the gastrointestinal tract, Streptococcus viridans, is the most common culprit. It gets to the heart through the blood stream, often after injury to or manipulation of the GI tract - as in dental work. It is able to become attached to the heart lining in areas where the normal strong cleansing flow is interrupted in swirls and eddies by the abnormal hole or malformed heart valve.

Once a tiny colony of the bacteria is established on the inner surface of the heart, it grows into a large vegetation. Bits of this solid mass of germs then break off to seed any part of the body with colonies of bacteria.

Spiking fever results. A hallmark of bacterial endocarditis is petechiae of the extremities, especially under the finger- and toenails - so-called splinter hemorrhages.

Diagnosis is made by suspicion, by ultrasound of the heart, and by blood culture tests to determine the causative organism and the best antibiotic choices. Treatment is long-term intravenous antibiotic therapy.

The germ is usually sensitive to penicillin, which is often prescribed as a preventative before any kind of dental work or bowel surgery to children with known predisposing conditions such as septal defects or heart valve malformations. As of May, 2007 there are new guidelines for selecting which children should receive this treatment (prophylaxis).

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