In 183 children with infective endocarditis at CHBAH, Johannesburg (1993-2015), congenital heart disease was the most common association, followed by structurally normal hearts in premature infants and patients with central venous catheters; the 56% complication rate and 24% mortality rate highlight the devastating outcomes of IE.
Congenital heart disease was the most common underlying condition among paediatric IE patients, followed by structurally normal hearts and rheumatic heart disease.
Children with IE and structurally normal hearts had identifiable non-cardiac risk factors, notably underlying sepsis, central venous catheters, prematurity and HIV.
Staphylococcus aureus and Streptococcus viridans were the most common pathogens.
More than half of patients developed complications.
Overall mortality was 23.5%, with cardiac failure and vascular complications associated with a high risk of mortality.
The study was a retrospective descriptive analysis of all paediatric IE cases over 23 years at a single South African tertiary hospital.
This study reviewed the records of 183 children treated for infective endocarditis, an infection of the inner lining of the heart, at a large public hospital in Johannesburg, South Africa, over 23 years. Little information exists on this condition in children in lower-income settings, particularly in Sub-Saharan Africa. About half of the children had a heart defect present from birth, and about 14% had rheumatic heart disease. Roughly a quarter had structurally normal hearts. Among children with normal hearts, the infection was often linked to other factors such as a severe underlying infection (sepsis), a central venous catheter, premature birth, or HIV. The most common germs were Staphylococcus aureus and Streptococcus viridans. More than half of the children (56%) had complications, including heart failure, worsening damage to heart valves, and blockages or weakened blood vessels caused by infected material travelling through the bloodstream. About 1 in 4 children (23.5%) died. Heart failure and blood vessel complications were associated with a higher risk of death. This research suggests that infective endocarditis in children in this setting remains very serious, and that both children with heart disease and those with catheters or premature birth are affected. As a single-hospital retrospective study, its findings may not apply everywhere.
Ooka M, Cilliers A. (2026). Infective endocarditis in children: a 23-year experience at a Southern African tertiary institution.. Cardiovascular journal of Africa. https://doi.org/10.5830/CVJA-2026-024