Children who have congenital heart defects or who have rheumatic heart disease may develop infective endocarditis in which the endocardial tissue is infected by organisms such as Streptococcus viridans, Staphylococcus aureus, or Staphylococcus epidermidus. The child presents with general malaise, arthralgia, fever, splenomegaly and the signs of their underlying heart disease. The classical signs of splinter haemorrhages, petechiae, haemorrhagic lesions (Janeway lesions), tender Osler’s nodes, or Roth’s spots (retinal haemorrhage) are not always seen in children. Microscopic haematuria is common, as is anaemia and a raised ESR. Serial blood cultures may reveal the causative organism. .
