Infective endocarditis in developing countries: An update (original) (raw)
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Prospective study of infective endocarditis from a developing country
American Heart Journal, 2011
Background There has been a considerable change in the profile of infective endocarditis (IE) worldwide. However, prospective studies of IE from developing countries are rare. Aim The aim of this study was to evaluate predisposing factors, clinical presentation, echocardiography, microbiology, in-hospital course, and outcomes of patients with definite IE. Methods This was a prospective observational study of consecutive cases of definite IE as per the modified Duke criteria. Results Between 2004 and 2006, a total of 104 cases of definite IE were identified. The mean age was 23.5 years (interquartile range, 9-38 years), with a male preponderance (2.5:1). Congenital heart disease accounted for 39.4% cases of IE, followed by native valve disease (29.8%), prosthetic valve disease (20%), and normal valves (7.7%). Echocardiography was diagnostic in 96.7% of the patients. Positive cultures were obtained in only 41% of the cases, with staphylococci and streptococci being the most common organisms. Seventy-three percent of the cases had at least 1 major complication. Only 15% of the cases underwent surgery for IE. The in-hospital mortality was 26%. On multivariate analysis, an underlying heart disease other than native valve disease and septic shock were independent predictors of mortality. Conclusion The mean age of IE in India is significantly lower than that in the West. Unlike previous reports, congenital heart disease is the major predisposing factor. Culture positivity rates and surgery for IE are unacceptably low. In conclusion, IE in India is associated with a very high morbidity and mortality.
International Journal of Cardiology, 2005
Total 198 episodes of Duke ''definite'' infective endocarditis (IE) in 192 patients observed over last 10 years were studied [141 males and 51 females, mean age 27.6 F 12.7 years (range 4 -68 years)]. Majorities of patients (76.5%) were below 40 years of age. Rheumatic heart disease (RHD) was the commonest underlying heart disease (present in 46.9% patients). Probable source of infection could be identified in only 16.6% episodes. None of our patient was intravenous drug abuser. Fever (90.0%), anemia (81.0%), clubbing (58.1%), splenomegaly (60.6%), changing/new murmur (22.7%) were the common clinical findings. Vegetations were present in 89.9% episodes. Blood cultures were positive in 134 (67.7%) episodes (streptococci in 23.2%, staphylococci in 19.7%, gram negative in 13.6%, enterococci in 8.1%, polymicrobial and fungal in 1.5% episodes each). Complications were cardiovascular [congestive heart failure (CHF) in 41.9%, atrioventricular block in 1.5%, cardiac temponade and acute myocardial infarction in 0.5% each), neurological in 16.6%, renal in 13.1% and embolisms in total 21.7% episodes. Total 182 (91.9%) episodes in 176 patients were managed completely [(medical in 140 (76.9%) and surgical in 42 (23.1%) episodes] while patients in remaining 16 (8.1%) episodes left against medical advises before completion of therapy. Total 21% patients (37 out of 176 completely treated patients) died during therapy (cause of deaths; CHF in 11, septicemia in 10, cerebral embolism in 7, post cardiac surgery in 5, ruptured cerebral mycotic aneurysm in 2, ventricular tachycardia in 2 patients). On stepwise logistic regression analysis; cardiac abscess and CHF were independent predictors of cardiac surgery. Similarly, CHF, renal failure and prosthetic valve dysfunction were independent predictors of mortality. To conclude, spectrum of IE in our country is different from the west, but quite similar as reported from developed countries about 40 years ago. IE in our country occurs in relatively younger population with RHD as the commonest underlying heart disease. Streptococci are still the commonest responsible microorganisms. Morbidity and mortality are still high. Early cardiac surgery, whenever indicated, helps in improving outcome of these patients.
A Study of Changing Trends of Infective Endocarditis In An Indian Set Up
From multiple studies conducted previously, it is quite evident that Infective Endocarditis(IE) is changing in terms of its clinical presentations, causative organisms and other factors creating challenges in diagnosis and treatment. To evaluate the recent changes in different factors associated with this entity we conducted a descriptive cross-sectional study in an Indian set up. Age, sex, presenting features, treatment history, complication, echocardiographic findings were examined in definite cases of Infective Endocarditis(IE). Total 70 patients were examined, among them 61 patients had mono valvular Infective Endocarditis(IE) and 9 patients had multi valvular Infective Endocarditis(IE). There was an overall female preponderance. Mean age of the patients was 41 years. Rheumatic heart disease was the most common predisposing factor and fever was the most common symptom overall. Most of the patients were culture negative and among culture-positive patients, streptococcus and staphylococcus had the same frequency. We noticed some recent changes in the epidemiology of Infective Endocarditis(IE) like an increase in the mean age of the patients, an increased proportion of staphylococcal Infective Endocarditis(IE) and increase in Infective Endocarditis(IE) with degenerative heart disease. These changes point to the fact that the profile of Infective Endocarditis has started to change in India.
International Journal of Clinical Medicine, 2014
OBJECTIVES: We examined the microbiological spectrum, clinical profile, echocardiographic features and in-hospital outcomes of patients with definitive IE. METHODS: A total of 75 consecutive cases of definitive infective endocarditis (IE), admitted between January 2011 and January 2013, were included in the study. This was a prospective study enrolling all the consecutive definitive cases of IE admitted at U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC), Ahmedabad, India. Only the patients who met the modified Duke's definitive criteria for IE were included in the study. We compared enrolled patients clinicoepidemiologic features and outcomes to subjects in the west. RESULTS: The mean age was 27.46 ± 17.11 years with a male preponderance (2.26:1). The rheumatic heart disease (41.3%) was the commonest underlying disease followed by coronary heart disease (34.7%). The blood culture was positive in 40% of episodes with commonest organisms being staphylococci (16%) and streptococci (12%). Complications were cardiovascular in 40 (53.3%) cases (congestive heart failure in 42.7%, atrioventricular block in 6.7%), septic shock in 20 (26.7%), neurological in 23 (30.7%) (cerebrovascular stroke in 20%, central nervous system hemorrhage in 5.3%, encephalopathy in 5.3%) and renal failure in 20 (26.7%) of cases respectively. Only 12 (16%) patients underwent surgery for IE. The total in hospital mortality rate was 22 (29.3%). On multivariate analysis, congestive heart failure, renal failure, neurological abnormalities, age < 20 years and septic shock were independent predictors of mortality. CONCLUSIONS: The spectrum of infective endocarditis is different in Indian population compared to the west and carries a substantial morbidity and mortality. The rheumatic heart disease is still the commonest underlying heart disease in our population. The culture positivity rates and surgery for infective endocarditis are unacceptably low. Early cardiac surgery may help to improve the outcomes of these patients. S. R. Jain et al. 178 Keywords Infective Endocarditis; Rheumatic Heart Disease; Echocardiography S. R. Jain et al. 179 Table 1. Underlying heart disease in 75 patients of infective endocarditis. Underlying heart disease n = 75 patients Rheumatic heart disease, n (%) 31 (41.3%) Mitral valve disease, n (%) 28 (37.3%) Aortic valve disease, n (%) 17 (22.7%) Mixed valvular heart disease, n (%) 14 (18.7%) Congenital heart disease, n (%) 26 (34.7%) Post tetrology of fallot ICR 1 , n (%) 7 (9.3%) Post ICR with RV to PA conduit, n (%) 1 (1.3%) Post ICR with PPI 2 , n (%) 1 (1.3%) Tetrology of fallot, n (%) 1 (1.3%) Ventricular septal defect, n (%) 4 (5.3%) Bicuspid aortic valve, n (%) 4 (5.3%) Patent ductucs arteriosus, n (%) 2 (2.7%) Subaortic membrane, n (%) 2 (2.7%) RSOV 3 with VSD, n (%) 1 (1.3%) Post truncus arteriosus reapir, n (%) 1 (1.3%) Post Patent ductucs arteriosus ligation, n (%) 1 (1.3%) Tetrology of fallot with post BT 4 shunt, n (%) 1 (1.3%) Prosthetic valves endocarditis, n (%) 7 (9.3%) Mitral valve prolapsed, n (%) 5 (6.7%) Degenerative valve disease, n (%) 2 (2.7%)
Infective endocarditis in the Lao PDR: Clinical characteristics and outcomes in a developing country
International journal of cardiology, 2015
Data on infective endocarditis (IE) in Southeast Asia are scarce. To describe the clinical epidemiology of IE in Lao PDR, a lower middle-income country. A single centre retrospective study at Mahosot Hospital, Vientiane. Patients aged over 1year of age admitted 2006-2012 to Mahosot Hospital with definite or possible IE by modified Duke criteria were included. Thirty-six patients fulfilled the inclusion criteria; 33 (91.7%) had left-sided IE. Eleven (30.6%) had definite IE and 25 (69.4%) possible left-sided IE. Median age was 25years old [IQR 18-42]. Fifteen patients (41.7%) were males. Underlying heart diseases included: rheumatic valve disease in 12 (33.3%), congenital heart disease in 7 (19.4%), degenerative valve disease in 3 (8.3%), and of unknown origin in 14 (38.9%) patients. Native valve IE was present in 30 patients (83.3%), and prosthetic valve IE in 6 patients (16.7%). The most frequent pathogens were Streptococcus spp. in 7 (19.4%). Blood cultures were negative in 22 pati...
Journal of Investigative Medicine, 2023
The aim of this study was to describe the pattern, characteristics, and outcomes of infective endocarditis (IE) in Yemen and compare the results with the findings of a Western university hospital. Patients (pts) with a final diagnosis of IE observed in Al-Thawra Sanaa Cardiac Center were prospectively enrolled in 1-year time period. Clinical and diagnostic findings were compared to clinical and diagnostic data of 50 pts with IE observed at Sapienza University Hospital in Rome, Italy. The mean age was 38 6 6. Predisposing factors for IE were rheumatic heart disease (RHD) in 34 pts (68%), congenital heart disease in 9 pts (18%), prosthetic valve IE in 4 pts (8%), and previous IE in 3 pts (6%). Transthoracic echocardiography (TTE) was done in 50 pts and transesophageal echocardiography (TEE) in 25. Blood cultures were taken in all pts and were positive in 3 pts (6%) and negative in 47 (94%). TTE was positive in 34/50 pts (68%) and TEE in 20/25 (80%). Compared to Sapienza University pts, Al-Thawra Cardiac Center pts had a younger age (p = 0.003), more predisposing RHD (p = 0.0004), less prosthetic heart valves IE (p = 0.002), and more negative blood cultures (p = 0.0001). IE is still a common disease in Yemen among RHD pts and affects the younger age group. It has severe complications which need early diagnosis and proper management. Echocardiography is of prime diagnostic value in the absence of positive blood cultures. An effort should be made to prevent rheumatic fever and RHD.
Journal of Child Science
With an increasing number of children with congenital heart disease (CHD) undergoing corrective treatments, improved pediatric intensive care, better antimicrobial treatments, and a relative decrease in rheumatic heart disease over the years, the epidemiology of pediatric infective endocarditis in India may be undergoing a change. The study was done in the department of pediatrics of a tertiary care teaching hospital of North India. A retrospective analysis of case records of children (<12 years) admitted with a diagnosis of infective endocarditis (IE) from January 2013 to April 2019 was performed. Modified Duke's criteria were used to diagnose IE. There were 21 children diagnosed with infective endocarditis during this period. The mean age at presentation was 70 months (range: 2.5–144 months). CHD (n = 13/21, 61.9%) was the most common predisposing condition. A total of 28% (6/21) patients had no preexisting structural heart disease. Nine percent (2/21) had rheumatic heart d...
Infective Endocarditis in Northeastern Thailand
Emerging Infectious Diseases, 2014
Despite rigorous diagnostic testing, the cause of infective endocarditis was identified for just 60 (45.5%) of 132 patients admitted to hospitals in Khon Kaen, Thailand during January 2010-July 2012. Most pathogens identified were Viridans streptococci and zoonotic bacteria species, as found in other resource-limited countries where underlying rheumatic heart disease is common.