Infective endocarditis (sometimes called ‘bacterial endocarditis’ or just ‘endocarditis’) is a rare but serious infection of the inner lining of the heart. It usually involves one or more of the heart valves.

The infection is caused by bacteria entering the bloodstream, multiplying in number and damaging the structures of the heart, including the valves and muscle (myocardium).

Infective endocarditis can be life-threatening infection and typically requires hospitalisation for  treatment.

Children with certain heart conditions/defects are at higher risk of infective endocarditis because bacteria in your bloodstream are more likely to infect a heart that already has some damage.

Children who are more at risk of bloodstream infections (e.g., those with an intravascular catheter or an underactive immune system) are also at greater risk of infective endocarditis.

Endocarditis must be diagnosed and treated quickly.

Signs and symptoms

Infective endocarditis symptoms can develop over a few days or several weeks. Signs and symptoms can include:

• a fever (temperature higher than 38 °C), chills and night sweats
• muscle aches and pains
• shortness of breath
• headaches
• chest pain
• red or brown marks under the fingernails or toenails
• painless red spots on the palms or soles of feet
• painful lumps on fingertips or toes
• extreme tiredness and weight loss
• swelling in the feet or ankles

When to seek help

Take your child to your GP as soon as possible or go to your nearest emergency department if they develop any of the above symptoms of infective endocarditis.

If it’s not an emergency but you have any concerns or questions, contact yourGP or 13 Health (13 43 2584).

If your child is under the care of a cardiologist, contact their cardiac care coordinator.

Diagnosis

Infective endocarditis is usually diagnosed by considering medical history and symptoms, and an examination. The examination will usually include listening to your child’s heart for new or changing heart murmurs. A doctor may also order some tests such as an electrocardiogram (ECG), an echocardiogram, a chest X-ray, and MRI or a PET scan and blood and urine (wee) tests.

Treatment

The main treatment for infective endocarditis is an extensive course of intravenous (IV) antibiotics.

In severe cases, surgery may be required to remove infected tissue or replace damaged heart valves.

Prevention of endocarditis

If your child is at risk of endocarditis, you can help prevent it by:

• ensuring they brush their teeth daily and practice good oral hygiene to reduce the risk of bacteria entering through the mouth (i.e., through tooth decay)
• regular dental check-ups.
• Avoiding ear and body piercing.

Preventative antibiotics

Children at risk of endocarditis may be prescribed antibiotics before and/or after surgical and dental procedures, or if they have certain medical conditions. For example, a child will be prescribed antibiotics if they:

• have a cyanotic heart condition.
• have had cardiac surgery which included use of prosthetic material (for 6 months after surgery)
• have had a therapeutic device placed by cardiac catheterisation (for 6 months after placement)
• suffer from a residual defect following cardiac surgery which has included the use of prosthetic material.
• have had a heart valve replaced or repaired using prosthetic material.
• have been previously diagnosed with infective endocarditis.
• have had a heart transplantation where the heart valves are abnormal.
• are of Aboriginal or Torres Strait Islander descent and have previously been diagnosed with rheumatic heart disease.
• are having a deep clean of their teeth by a dentist.
• having a tooth removed.
• are having mouth surgery.

Developed by the Cardiology Department, Queensland Children's Hospital. We acknowledge the input of consumers and carers. Illustrations courtesy of the Royal Children’s Hospital, Melbourne, Australia.

Resource ID: FS078. Reviewed: January 2024.

Disclaimer: This information has been produced by healthcare professionals as a guideline only and is intended to support, not replace, discussion with your child’s doctor or healthcare professionals. Information is updated regularly, so please check you are referring to the most recent version. Seek medical advice, as appropriate, for concerns regarding your child’s health.