C F N Koegelenberg1, A F Doubell, H Orth, H Reuter. 1. Department of Internal Medicine, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa.
Abstract
BACKGROUND: The last 50 years have seen major changes in the epidemiology of infective endocarditis (IE). AIM: To evaluate local patient characteristics, risk factors, clinical sequelae, microbiology, morbidity and mortality in patients with definite IE. DESIGN: Prospective observational study. METHODS: Over a three-year period, patients referred with probable IE were prospectively enrolled. All received a standardized diagnostic evaluation. Epidemiological data were documented; underlying risk factors for IE were sought. Initial evaluation and follow-up (to 6 months) included the documentation of vascular or immunological phenomena, morbidity and mortality. RESULTS: Of 92 patients referred with probable IE, 47 had definite IE. These patients had a mean age of 37.7 years with a male predominance (1.6:1). Rheumatic heart disease was present in 36 (76.6%). Eight had prosthetic valves. Three had congenital heart disease, mitral valve prolapse or multiple central intravascular catheters, respectively. All denied the use of intravenous recreational drugs and only one tested seropositive for HIV. Renal involvement (59.6%) and clubbing (29.8%) were commonly observed. The 6-month mortality rate was 35.6%, while 44.7% needed valvular replacement. An aetiological diagnosis was made in 21, with viridans streptococci the most common isolate. DISCUSSION: Infective endocarditis in the Western Cape of South Africa is a disease of younger adults, with a male predominance. Rheumatic heart disease is the major predisposing factor. Degenerative heart disease and intravenous drug abuse are not important risk factors. Our data do not support the notion that HIV infection is an independent risk factor for IE. Local mortality rates are much higher than recent international figures, as is the proportion of 'culture-negative' IE.
BACKGROUND: The last 50 years have seen major changes in the epidemiology of infective endocarditis (IE). AIM: To evaluate local patient characteristics, risk factors, clinical sequelae, microbiology, morbidity and mortality in patients with definite IE. DESIGN: Prospective observational study. METHODS: Over a three-year period, patients referred with probable IE were prospectively enrolled. All received a standardized diagnostic evaluation. Epidemiological data were documented; underlying risk factors for IE were sought. Initial evaluation and follow-up (to 6 months) included the documentation of vascular or immunological phenomena, morbidity and mortality. RESULTS: Of 92 patients referred with probable IE, 47 had definite IE. These patients had a mean age of 37.7 years with a male predominance (1.6:1). Rheumatic heart disease was present in 36 (76.6%). Eight had prosthetic valves. Three had congenital heart disease, mitral valve prolapse or multiple central intravascular catheters, respectively. All denied the use of intravenous recreational drugs and only one tested seropositive for HIV. Renal involvement (59.6%) and clubbing (29.8%) were commonly observed. The 6-month mortality rate was 35.6%, while 44.7% needed valvular replacement. An aetiological diagnosis was made in 21, with viridans streptococci the most common isolate. DISCUSSION: Infective endocarditis in the Western Cape of South Africa is a disease of younger adults, with a male predominance. Rheumatic heart disease is the major predisposing factor. Degenerative heart disease and intravenous drug abuse are not important risk factors. Our data do not support the notion that HIV infection is an independent risk factor for IE. Local mortality rates are much higher than recent international figures, as is the proportion of 'culture-negative' IE.
Authors: Daniel C Desimone; Imad M Tleyjeh; Daniel D Correa de Sa; Nandan S Anavekar; Brian D Lahr; Muhammad R Sohail; James M Steckelberg; Walter R Wilson; Larry M Baddour Journal: Circulation Date: 2012-06-11 Impact factor: 29.690
Authors: Liesl Zühlke; Mark E Engel; Ganesan Karthikeyan; Sumathy Rangarajan; Pam Mackie; Blanche Cupido; Katya Mauff; Shofiqul Islam; Alexia Joachim; Rezeen Daniels; Veronica Francis; Stephen Ogendo; Bernard Gitura; Charles Mondo; Emmy Okello; Peter Lwabi; Mohammed M Al-Kebsi; Christopher Hugo-Hamman; Sahar S Sheta; Abraham Haileamlak; Wandimu Daniel; Dejuma Y Goshu; Senbeta G Abdissa; Araya G Desta; Bekele A Shasho; Dufera M Begna; Ahmed ElSayed; Ahmed S Ibrahim; John Musuku; Fidelia Bode-Thomas; Basil N Okeahialam; Olukemi Ige; Christopher Sutton; Rajeev Misra; Azza Abul Fadl; Neil Kennedy; Albertino Damasceno; Mahmoud Sani; Okechukwu S Ogah; Taiwo Olunuga; Huda H M Elhassan; Ana Olga Mocumbi; Abiodun M Adeoye; Phindile Mntla; Dike Ojji; Joseph Mucumbitsi; Koon Teo; Salim Yusuf; Bongani M Mayosi Journal: Eur Heart J Date: 2014-11-25 Impact factor: 29.983