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Pediatric Heart (Expert Forum)
skin infection and vsd
Answered by
Jeffrey R Boris, M.D. - Pediatric Cardiology, Ambulatory Cardiology
The Children’s Hospital of Philadelphia
Philadelphia - PA
Questions in this forum are answered by pediatric cardiologists, cardiothoracic surgeons and anesthesiologists from The Children's Hospital of Philadelphia. This forum is for questions and support about pediatric heart problems, symptoms and topics such as heart murmurs, palpitations, fainting, chest pain, congenital heart defects (including management and intervention), fetal cardiology, adult congenital cardiology, arrhythmias and pre-participation athletic screening.
skin infection and vsd
by 123abcs, May 11, 2009 03:28PM
Hi, my 5 y/o son has a vsd, which is finally almost closed!! Anyway, he has an infected fingertip right now, it is red and swollen all around the nail down to the top knuckle. I was wondering if there is a risk of endocarditis from this type of infection. Thanks you!
Doctor's Answer
by Jeffrey R Boris, M.D., May 12, 2009 03:31PM
, May 12, 2009 03:31PMTo: 123abcs
Dear Abcs,
I am glad that your son’s ventricular septal defect (VSD) is nearly closed. Based on what you are suggesting, the defect is quite small. As you have implied, VSDs do have a somewhat increased risk of associated infective endocarditis, a bacterial infection of the lining of the heart. These infections occur after bacteria which are floating around the bloodstream and which have avoided the immune system get into the area where the jet of blood has caused turbulence and exposed some proteins under the cells lining the heart. These proteins allow platelets to collect and cause tiny clots that serve both as great food as well as hiding places for the bacteria. For our other readers, infective endocarditis can be quite serious and even life threatening.
It is difficult for me to know what risk your son has, as I don’t know exactly how small the VSD is, nor do I know how bad the infection of his finger is or if it may be putting bacteria into his bloodstream. I also don’t know with what bacteria he is infected. The creation of endocarditis depends on all of these things. If the VSD is so small that it can’t be heard, the likelihood for increased risk of infection is probably no greater than if he didn’t have a VSD. However, if the VSD is still audible on examination, then he probably still has the increased risk. Usually, the risk of infection is increased if there is greater blood supply to the infected area so that it can more easily spread bacteria. This includes the mouth, intestinal tract, airway, etc. Fingers have somewhat less of a blood supply, so the risk is probably less from that standpoint; that said, I can’t say that the risk is zero.
At this point, I would definitely have your primary care provider assess his finger to better see what treatment needs to be given, regardless of the risk of endocarditis. Depending on what it looks like, he may need something simple, like repeated hot water soaks, or something more complex, like incision and drainage of an abscess and/or consideration of antibiotic therapy. If it appears to be a complex infection, antibiotics may be indicated if only to stop the spread of the infection, inflammation, and local tissue damage. Right now, it sounds like this is probably the bigger risk for him.
I am glad that your son’s ventricular septal defect (VSD) is nearly closed. Based on what you are suggesting, the defect is quite small. As you have implied, VSDs do have a somewhat increased risk of associated infective endocarditis, a bacterial infection of the lining of the heart. These infections occur after bacteria which are floating around the bloodstream and which have avoided the immune system get into the area where the jet of blood has caused turbulence and exposed some proteins under the cells lining the heart. These proteins allow platelets to collect and cause tiny clots that serve both as great food as well as hiding places for the bacteria. For our other readers, infective endocarditis can be quite serious and even life threatening.
It is difficult for me to know what risk your son has, as I don’t know exactly how small the VSD is, nor do I know how bad the infection of his finger is or if it may be putting bacteria into his bloodstream. I also don’t know with what bacteria he is infected. The creation of endocarditis depends on all of these things. If the VSD is so small that it can’t be heard, the likelihood for increased risk of infection is probably no greater than if he didn’t have a VSD. However, if the VSD is still audible on examination, then he probably still has the increased risk. Usually, the risk of infection is increased if there is greater blood supply to the infected area so that it can more easily spread bacteria. This includes the mouth, intestinal tract, airway, etc. Fingers have somewhat less of a blood supply, so the risk is probably less from that standpoint; that said, I can’t say that the risk is zero.
At this point, I would definitely have your primary care provider assess his finger to better see what treatment needs to be given, regardless of the risk of endocarditis. Depending on what it looks like, he may need something simple, like repeated hot water soaks, or something more complex, like incision and drainage of an abscess and/or consideration of antibiotic therapy. If it appears to be a complex infection, antibiotics may be indicated if only to stop the spread of the infection, inflammation, and local tissue damage. Right now, it sounds like this is probably the bigger risk for him.
Member Comments (2)
by 123abcs, May 12, 2009 04:24PM
Thank you so much!! I have been doing warm salt water soaks and his finger is starting to look better, so I think we can avoid a trip to the doctors.
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