Late-Stage Symptoms of Subacute Bacterial Endocarditis in Children

Subacute bacterial endocarditis (SBE) in children typically refers to an infection of the heart's inner lining that lasts for more than six weeks. This condition generally presents with milder systemic symptoms compared to its acute counterpart, and the illness can persist for several months. The most common causative agent is alpha-hemolytic streptococcus, particularly Streptococcus viridans, which is part of the normal flora found in the mouth and upper respiratory tract.

Progression and Clinical Manifestations

As the disease progresses into its later stages, certain clinical signs and symptoms become more evident. One notable change is the improvement or alteration of heart murmurs. This can occur due to the healing of damaged heart valves or the detachment of vegetations that had previously disrupted normal blood flow.

Cutaneous and Peripheral Signs

In the later phases of the illness, microvascular embolization may lead to characteristic skin findings. These include the appearance of small, scattered petechiae—tiny red or purple spots caused by minor bleeding from capillaries—on the skin and mucous membranes. In addition, painless, purplish nodules known as Osler's nodes may develop on the pads of the fingers or toes. These are thought to result from immune complex deposition rather than direct bacterial seeding.

Children may also develop clubbing of the fingers or toes, a condition marked by the widening and rounding of the fingertips due to chronic tissue hypoxia or inflammatory responses. This is a nonspecific sign but can be indicative of chronic infection or cardiovascular disease.

Systemic Complications

If embolic events affect internal organs, organ dysfunction may occur. For example, renal involvement can lead to hematuria or proteinuria, while splenic or hepatic infarctions may cause organ enlargement and impaired function. Neurological complications such as stroke or brain abscess can also arise if infected emboli travel to the central nervous system.

Parents and caregivers should be vigilant for signs of organ involvement, including fatigue, decreased urine output, abdominal discomfort, or neurological deficits. Early recognition and treatment are crucial in preventing long-term damage and improving outcomes for affected children.