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Volume 27, Number 3—March 2021
Synopsis

Clinical Features and Comparison of Kingella and Non–Kingella Endocarditis in Children, Israel

Alexander Lowenthal1, Hila Weisblum-Neuman1, Einat Birk, Liat Ashkenazi-Hoffnung, Itzhak Levy, Haim Ben-Zvi, Gabriel Amir, Georgy Frenkel, Elchanan Bruckheimer, Havatzelet Yarden-Bilavsky, Dafna Marom, Eran Shostak, Elhanan Nahum, Tamir Dagan, Gabriel Chodick, and Oded ScheuermanComments to Author 
Author affiliations: Tel-Aviv University, Tel-Aviv, Israel (A. Lowenthal, H. Weisblum-Neuman, E. Birk, L. Ashkenazi-Hoffnung, I. Levy, H. Ben-Zvi, G. Amir, G. Frenkel, E. Bruckheimer, H. Yarden-Bilavsky, D. Marom, E. Shostak, E. Nahum, T. Dagan, G. Chodick, O. Scheuerman); Schneider Children’s Medical Center of Israel, Petach-Tikva, Israel (A. Lowenthal, H. Weisblum-Neuman, E. Birk, L. Ashkenazi-Hoffnung, I. Levy, G. Amir, G. Frenkel, E. Bruckheimer, H. Yarden-Bilavsky, E. Shostak, E. Nahum, T. Dagan, O. Scheuerman); Rabin Medical Center, Beilinson Hospital, Petach-Tikva (H. Ben-Zvi); Tel Aviv Sourasky Medical Center, Tel Aviv (D. Marom)

Main Article

Table 2

Comparison of clinical, laboratory, and imaging characteristics of pediatric infective endocarditis case-patients by causative pathogen, Israel, 1994–2019*

Characteristic Kingella, n = 19 (32%) Non-Kingella, n = 41 (68%) p value
Temperature, °C, median (IQR) 40 (39.45–40) 39 (38.6–39.8) 0.003
Fever duration before admission, d, median (IQR) 7 (4.50–14) 6 (3–14) 0.43
Hepatosplenomegaly 4 (21) 24 (58) 0.015
Oral aphthae 5 (26) 0 (0) 0.003
Ocular findings 1 (5) 8 (19) 0.294
Systemic emboli 7 (37) 14 (34) 1
Pulmonary emboli 0 (0.0) 2 (5) 0.837
Seizures 3 (16) 6 (15) 1
New onset murmur 7 (37) 10 (24) 0.492
Conduction disturbance 1 (5) 2 (5) 1
Microhematuria 5 (26) 23 (56) 0.061
Leukocyte count K/mL, mean (SD) 20.87 (+ 12.39) 16.39 (+ 9.58) 0.131
Neutrophils K/mL, mean (SD) 12.98 (+ 8.49) 12.43 (+ 8.67) 0.821
Lymphocytes K/mL, mean (SD) 4.27 (+ 3.04) 2.21 (+ 1.81) 0.002
NLR, mean (SD) 4.7 (6.71) 10.7 (11.3) 0.055
Hemoglobin, mean (SD) 10.00 (+ 1.36) 10.39 (+ 2.27) 0.489
Platelets (100 K/mL), mean (SD) 220.16 (+ 203.30) 243.85 (+ 178.53) 0.649
C-reactive protein, mean (SD) 12.56 (+ 6.79) 12.49 (+ 10.75) 0.979
ESR, mean (SD) 65.92 (+ 38.86) 64.19 (+ 34.34) 0.89
No. positive blood cultures, median (IQR) 1 (1–2) 4 (3–5) <0.001†
Time to eradication, d, median (IQR)
 2 (2–3)
 3 (2–5)
 0.017
Echocardiography
Mural thrombus 1 (5) 2 (5) 1
Reduced ventricular function 4 (21) 11 (27) 0.873
Vegetation 12 (63) 20 (49) 0.447
Left-sided involvement‡
 12 (80)
 15 (65)
 0.297
Major Duke criteria
Culture 7 (37) 40 (98) <0.001
Echocardiography
 16 (84)
 23 (56)
 0.067
Minor Duke criteria
Fever 19 (100) 39 (95) 0.837
Congenital heart disease 10 (52) 31 (76) 0.138
Vascular 8 (42) 14 (34) 0.759
Immunologic 0 (0) 9 (22) 0.068
Blood culture
 11 (58)
 1 (2)
 <0.001
Summary
Definite 14 (74) 30 (73) 0.768
Possible 5 (23) 11 (27) 0.768

*Values are no. (%) except as indicated. All laboratory results are at admission apart from temperature, which we recorded as the highest in the 24 h before admission. ESR, erythrocyte sedimentation rate; IQR, interquartile range; NLR, neutrophil–lymphocyte ratio.
†By Mann–Whitney test.
‡Percentage of left-sided involvement in patients with echocardiographic findings.

Main Article

1These authors contributed equally to this article.

Page created: January 21, 2021
Page updated: February 21, 2021
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