Tricuspid valve endocarditis in two children with normal hearts: diagnosis and therapy of an unusual clinical entity

Staphy lococcus aureus has become a more impor tan t pa thogen in both hospitaland communi ty-acqui red infections over the last decade. ~ The exact incidence of endocarditis in S. aureus septicemia remains controversial, with est imates ranging from as high as 60% in early reports to less than 10% in recent reviews. 2 S. aureus sept icemia in chi ldhood and adolescence is par t icular ly devastat ing when it occurs in previously heal thy children, ~,4 in whom it usually begins as a "flulike" illness. In association with this entity, endocardit is almost always involves the left side of the hear t , and occurs in the absence of the classic signs usually associated With subacute bacterial endocardit is , 1-5 making diagnosis difficult. S. aureus endocardit is involving the tr icuspid valve has been described only once before in a child with a normal heart . 6 We describe two chi ldren (aged 5 and 8 years), with previously normal hear ts and no evidence of immunodeficiency, with tricuspid valve endocarditis.