Possible Infective Endocarditis in 14 Years Old Male with Atrial Septal Defect and History of Rheumatic Heart Disease in Southwest Sumba: A Case Report from Remote District Hospital

Background: Infective endocarditis (IE) is a rare disease in children. The epidemiology of IE has shifted in recent years with congenital heart disease (CHD) as the common predisposed risk factor than rheumatic heart disease (RHD). While its incidence is low, it may cause serious complications such as heart failure to death. Case illustration: Fourteenth year-old male presented to emergency room with high fever history and unquantified weight loss. Patient was in the treatment history of RHD. Physical examination detected pansystolic murmur at the cardiac apex area with a fixed splitting of S2. The electrocardiograph showed a Katz-Wachtel phenomenon. On the 10th day of medication, patient was referred to cardiology department of West Sumba to perform an echocardiography. Etiological investigation revealed a secundum atrial septal defect, mitral, aortic and tricuspid regurgitations with 6 x 9 mm vegetation on the anterior mitral leaflet. A possible IE was made based on the modified Duke criteria. Ceftriaxone as the single antibiotic and heart failure therapy was administered although no blood culture was performed because of facility limitation in hospital. Patient showed an improved clinical condition and chooses conservative therapy as the next treatment program due to socio-economic limitations. Discussion: Left-sided cardiac valves regurgitation with an ASD is a rare condition, this can occur due to RHD in predisposed IE with vegetation as the hallmark lesion. Treatment of IE depends on specific antibiotic activity based on the blood cultures results. The newest recommendation showed Ceftriaxone as bactericidal antibiotics has better effect than bacteriostatic and preferred in combination for determining the standard duration?s therapy. Conclusions: Infective endocarditis should be suspected in febrile children with history of cardiac disease and single antibiotic therapy as ceftriaxone showed a good progression in treatment of IE although no blood culture was performed in remote area.