İnfektif Endokardit
Özet
İnfektif endokardit kalbin endokardiyal yüzeyinde, kardiyak kapakları (doğal ya da protez) veya yerleşik kalp cihazlarını içine alan bir hastalıktır. Pediatrik infektif endokardit, son dönemde geliştirilen tanısal teknikler ve yönetim yaklaşımlarında ilerlemeler sağlanmasına rağmen karmaşık bir hastalık olmaya devam etmektedir. Antimikrobiyal ajanlarla profilaksi yaklaşımları geliştirilmesine rağmen infektif endokardit çocuk ve adölesan yaş grubu için önemli bir morbidite ve mortalite sebebi olmaya devam etmektedir. Artan intravenöz ilaç kullanımı, dejeneratif kalp hastalıları, protez valvler, kalıcı kateterler, implante kardiyak cihazlar, diabet, immünsüpresyon ve konjenital kalp hastalıkları infektif endokardit sıklığının artmasına neden olmuştur. Pediatrik infektif endokarditte spesifik olmayan hafif semptomlarla hastalığın başlaması, klinisyenler için oldukça zorlayıcı bir durumdur. Semptomlar çocukluk yaş gruplarına göre de değişkenlik göstermektedir. Bu durum tanı konulmasını geciktirerek çocuklarda mortalitenin daha yüksek olmasına sebebiyet vermektedir. İnfektif endokardit tanısı özellikle altta risk faktörü olan hastalarda öncelikli olarak şüphe ile konulur. Tanının konulmasında modifiye Duke kriterlerinin oldukça faydası vardır. İnfektif endokardit tanısı konulur konulmaz zaman kaybetmeden tedavi başlanması gerekmektedir. Ampirik tedavi başlanıp etken tespit edildikten sonra mikroorganizmaya yönelik tedavi başlanmalıdır. İnfektif endokarditte antibiyotik ajanların kullanılmasına rağmen mortalite %20-25’dir. Dökümente edilmiş infektif endokarditi olan çocukların %50-60’ında ciddi morbidite oluşmaktadır, bunların en sık görüleni de aortik veya mitral valvleri içeren vejetasyonların sebep olduğu kalp yetmezliğidir. İnfektif endokardit için yüksek riskli hastalara, dental işlemler öncesi uygun profilaktik antibiyotik kullanımı korunma için oldukça önemlidir.
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