Endokarditida u dětí

1.8.2013

endokarditida-u-deti.jpg - kopie
endokarditida-u-deti.jpg - kopie
Endokarditida je nebezpečné infekční onemocnění srdce způsobené bakteriemi nebo plísněmi. Bakterie, které se dostanou do krevního oběhu během zubního nebo jiného chirurgického výkonu, se usadí v srdci a poškodí srdeční chlopně. Tím se vytvoří infikované krevní sraženiny, které se uvolní do krevního oběhu a putují do mozku, ledvin či plic a mohou způsobit selhání srdce, mozku nebo v nejhorším případě smrt. Jak se endokarditida projevuje, diagnostikuje a léčí najdete v tomto článku.

Endokarditida u dětí

Endokarditida je infekční onemocnění srdečních chlopní a vnitřní výstelky srdce, jehož příčinou je bakterie nebo plíseň. Toto zřídka se vyskytující onemocnění srdce se nejčastěji objevuje u dětí s vrozenými srdečními vadami, u dětí, které prodělaly revmatické srdeční onemocnění, u dětí, které mají zjizvené nebo umělé srdeční chlopně, které prodělaly endokarditidu nebo podstoupily srdeční operaci. Může se vyskytnout i u mladých lidí, kteří si píchají drogy nečistými jehlami.

Hlavním zdrojem infekce je bakterie, která se dostala do krevního oběhu (bakteriémie) během zubního nebo jiného chirurgického výkonu nebo diagnostického postupu provedeného na srdci, v nose a v hrdle, v močovém ústrojí nebo ve střevech. Bakterie se usadí v srdci a poškodí srdeční chlopně a výstelku. Na srdečních chlopních se tvoří infikované krevní sraženiny, které se uvolní do krevního řečiště a dostávají se do mozku, do plic, do ledvin nebo do sleziny. Neléčená endokarditida má za následek trvalé poškození srdce, mozku a jiných orgánů, selhání srdce a smrt.

Antibiotika před operací

Dětem s vrozenými srdečními vadami, s vadami srdečních chlopní, srdečním šelestem nebo dětem, které mají v anamnéze endokarditidu, hrozí při jakékoli operaci, při trhání zubů nebo dokonce při pouhém čištění zubů zvýšené nebezpečí vzniku endokarditidy. Má-li vaše dítě některou z uvedených nemocí, sdělte to vždy ošetřujícímu nebo zubnímu lékaři a požádejte, aby dítě dostalo před každým chirurgickým výkonem antibiotika jako prevenci před endokarditidou. Dítě by mělo mít vždy u sebe kartičku s popisem zdravotního stavu a s poznámkou, že před jakoukoliv operací musí dostat antibiotika.

Příznaky endokarditidy

Endokarditida se projevuje horečkou, neobvyklou únavou, ztrátou chuti k jídlu, dušností, bolestí hlavy, zimnicí, nočním pocením, bolestmi kloubů a pocitem celkově špatného zdravotního stavu. Příznaky se mohou vyvíjet pomalu nebo se objeví náhle. Při pomalém vývoji má dítě obvykle nejprve několik týdnů horečku, pak se projeví další příznaky. Nakonec se pod nehty na rukou vytvoří malé, tmavé čáry (zvané třískovité hemoragie). Infikované krevní sraženiny na srdečních chlopních jsou příčinou srdečního šelestu (abnormální zvuk v srdci). Také nepravidelný srdeční tep je projevem postupu nemoci. Dítě může mít také zvětšenou slezinu a otoky na rukou a na nohou.

Diagnóza endokarditidy

Lékaře bude zajímat, zda dítě trpí nějakou srdeční chorobou nebo má nějaké srdeční deformity, pak dítě důkladně vyšetří. Ke zjištění zdroje infekce nařídí provést vyšetření krve. Sedimentací erytrocytů se zjistí rozsah zánětu v srdečních chlopních, dále bude dítěti proveden kompletní krevní obraz a. rozbor moči. Lékař obvykle nechá provést dítěti rentgen srdce a plic, elektrokardiogram (kterým se měří elektrická aktivita srdce) nebo echokardiogram (zobrazení srdce pomocí zvukových vln neboli ultrazvuk).

Léčba endokarditidy

Lékař pošle dítě do nemocnice, kde bude dostávat nitrožilně antibiotika. Podle typu bakterie, která endokarditidu vyvolala, bude muset dítě brát antibiotika 2 až 6 týdnů. Léčba antibiotiky obvykle probíhá po celou dobu v nemocnici, možná je i v domácí péči. U některých děti je nutná operace, při které se nahradí postižené srdeční chlopně.

Po návratu z nemocnice musí být dítě v klidu až do úplného uzdravení. Dbejte, aby si dítě často protahovalo dolní končetiny jako prevenci tvorby krevních sraženin v žilách, které vznikají jako následek dlouhého pobytu na lůžku. Když dítě dostatečně zesílí, může se věnovat svým normálním činnostem. Následnou péči, která má zabránit recidivě onemocnění, poskytne dětský lékař.

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