scholarly journals Evolving trends in infective endocarditis in a developing country: a consequence of medical progress?

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Mohamed Sunil ◽  
Huynh Quoc Hieu ◽  
Ramesh Singh Arjan Singh ◽  
Sasheela Ponnampalavanar ◽  
Kelvin S. W. Siew ◽  
...  
Keyword(s):  
Health Care ◽  
Heart Disease ◽  
Infective Endocarditis ◽  
Rheumatic Heart Disease ◽  
Major Complication ◽  
Tertiary Hospital ◽  
Hospital Death ◽  
Medical Progress ◽  
Streptococcus Group ◽  
Rheumatic Heart

Abstract Background Staphylococcus has replaced streptococcus as the most common cause of infective endocarditis (IE) in developed health care systems. The trend in developing countries is less clear. Aim To examine the epidemiological trends of infective endocarditis in a developing nation. Methods Single-centre, retrospective study of patients admitted with IE to a tertiary hospital in Malaysia over a 12-year period. Results The analysis included 182 patients (n = 153 Duke’s definite IE, n = 29 possible IE). The mean age was 51 years. Rheumatic heart disease was present in 42%, while 7.6% were immunocompromised. IE affected native valves in 171 (94%) cases. Health-care associated IE (HCAIE) was recorded in 68 (37.4%). IE admission rates increased from 25/100,000 admissions (2012) to 59/100,000 admissions (2017). At least one major complication on admission was detected in 59 (32.4%) patients. Left-sided IE was more common than right-sided IE [n = 159 (87.4%) vs. n = 18 (9.9%)]. Pathogens identified by blood culture were staphylococcus group [n = 58 (40.8%)], streptococcus group [n = 51 (35.9%)] and Enterococcus species [n = 13 (9.2%)]. staphylococcus infection was highest in the HCAIE group. In-hospital death occurred in 65 (35.7%) patients. In-hospital surgery was performed for 36 (19.8%) patients. At least one complication was documented in 163 (85.7%). Conclusion Staphylococcus is the new etiologic champion, reflecting the transition of the healthcare system. Streptococcus is still an important culprit organism. The incidence rate of IE appears to be increasing. The rate of patients with underlying rheumatic heart disease is still high.

scholarly journals Rheumatic fever and rheumatic heart disease: how often we suspect infective endocarditis

2013 ◽  
Vol 34 (3) ◽  
pp. 17-20
Author(s):  
PN Shrestha ◽  
A Das ◽  
A Rayamajhi ◽  
C Mahaseth ◽  
UK Shrestha
Keyword(s):  
Heart Disease ◽  
Infective Endocarditis ◽  
Mitral Regurgitation ◽  
Rheumatic Fever ◽  
Rheumatic Heart Disease ◽  
Major Complication ◽  
Institute Of Medicine ◽  
Female Ratio ◽  
Valvular Lesion ◽  
Rheumatic Heart

Introduction: Rheumatic fever and rheumatic heart disease is a common problem in developing countries. Rheumatic valvular heart disease is one of the important risk factor for infective endocarditis. Methods: Retrospective study was conducted among 56 children admitted in cardiology ward of Kanti children hospital with the diagnosis of rheumatic fever or rheumatic heart disease during May 2008 to May 2010. Results: We found male to female ratio 2: 1, median age 12 (5-14yrs) with the most affected age group of 11-12 years. Common symptoms were fever (66%), dyspnea (68%), joint pain (50%), palpitation (30%), cough (16%) and chest pain (12%). Only 9% of patients had positive history of sore throat. Sixty percent patients were presented with features of congestive cardiac failure (CCF). A SO positive was found in 25 (44.6%) cases. The most common valvular lesion was mitral regurgitation (MR). Moderate to severe mitral regurgitation was found in 89% of cases. Tricuspid regurgitation (T R) was found in 57% of patients and aortic regurgitation (AR) in 55% of cases. Thirty-two patients (57%} had PAH in which 8 patients has severe PAH and 24 patients had mild to moderate PAH. Infective endocarditis was diagnosed in twenty patients (35.7%). Out of 20 patients 14 (70%)had vegetation in echocardiography. The mortality was 11% in this study. Conclusion: Infective endocarditis is the major complication of rheumatic heart disease among children of Nepal and so clinical suspecian is important whenever patients with rheumatic heart disease present with fever. DOI: http://dx.doi.org/10.3126/joim.v34i3.8911 Journal of Institute of Medicine, December, 2012; 34:17-20

Abstract 16175: Total Burden of Out-of-Pocket Costs for Penicillin Prophylaxis for Rheumatic Heart Disease in India: Results From the AIIMS Pediatric RHD Registry

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Anurag Mehta ◽  
Anita Saxena ◽  
Dhruv S Kazi
Keyword(s):  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
Rural Areas ◽  
Tertiary Hospital ◽  
Drug Costs ◽  
Transportation Costs ◽  
Major Barrier ◽  
Penicillin Prophylaxis ◽  
Rheumatic Heart ◽  
Out Of Pocket Costs

Introduction: Out-of-pocket costs are a major barrier to medication adherence in low and middle income countries and an important target for policy-level interventions. The total economic burden for patients receiving secondary penicillin prophylaxis for Rheumatic Heart Disease (RHD) is uncertain. Methods: We prospectively collected self-reported out-of-pocket drug, transportation, and provider costs from patients in the AIIMS Pediatric RHD Registry. Monthly costs were estimated by adjusting visit costs for frequency of drug administration. Because adverse drug reactions are rare, we did not collect complication-related costs. Mean (±SD) costs are reported in 2013 Indian Rupee (INR) and International Dollars (INT$). Results: In our registry, 230 patients provided cost data over 313 visits. The mean age was 11.8 (±2.9) years, and 83 (36%) were girls. The majority of patients resided in rural areas (n=197, 86%), and were from the lower and upper lower socioeconomic strata (n=160, 70%) on the modified Kuppuswami scale. Nearly all patients hailed from outside Delhi (91%), reflecting the referral population of our tertiary hospital. The monthly out-of-pocket cost was INR 74.92 (±109.00) or INT$ 4.04 (±5.88), drug cost forming 36% of the total costs (INR 26.71 [±11.6]; INT$ 1.44 [± 0.63]). Provider costs (INR 18.21 [±32.48]) and transportation costs (INR 30.00 [±106.51]) comprised 24% and 40% of total costs respectively. Provider and transportation costs exceeded the drug costs for 38% of the patients. Patients traveled 12 (±38) km round trip to obtain penicillin prophylaxis. Conclusions: Drug costs constitute only 36% of the total out-of-pocket cost of penicillin prophylaxis for RHD, with provider costs (24%) and transportation costs (40%) comprising the remainder. Because out-of-pocket costs can be a major barrier to long-term adherence, future efforts must be directed at improving access to and lowering total costs of penicillin prophylaxis for RHD.

scholarly journals RIGHT SIDED ENDOCARDITIS: CASE SERIES FROM MOROCCO

2021 ◽  
Vol 9 (4) ◽  
pp. 704-714
Author(s):  
A. Laalou ◽  
◽  
A. Chachi ◽  
A. Benbahia ◽  
S. Jourani ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Surgical Treatment ◽  
Infective Endocarditis ◽  
Rheumatic Heart Disease ◽  
Pulmonary Valve ◽  
Indwelling Catheters ◽  
Cardiac Devices ◽  
Wide Range ◽  
Rheumatic Heart

Objective: Compared with the extensive data on left sided infective endocarditis, right-sided infective endocarditis (RSIE) remains a rare condition. It accounts for 5–10% of all cases of infective endocarditis (IE) [1] [2] [3].Although it is predominantly encountered in the injecting drug user (IDU) population, where HIV and HCV infections often coexist, rheumatic heart disease remains the most important predisposing factor for IE in our context. The aim our study is to report clinical, investigation, management and outcome data in 5 patients diagnosed with RSIE in our department during the last 2 years. Methods: A retrospective analysis of data of 5 patients with right sided endocarditis in a tertiary care center from 2018 to 2020 was done. Results: All of our patients were young aged females none of them had cardiac devices or history of drug use. Persistent fever was the most common clinical presentation. Interestingly, 4 patients presented clinical heart failure. 3 patients had isolated tricuspid valve IE, one patient had isolated pulmonary valve IE, and one patient have both tricuspid and pulmonary valve IE. Blood cultures were negative in two cases, whilst two others were positive to Streptococcus (alpha) and one positive to Staphylococcus. 4 patients underwent surgical treatment after well conducted antibiotic therapy the indications were the presence of right heart failure secondary to severe tricuspid regurgitation and the size of the vegetations. Unfortunately, one patient died of massive pulmonary embolism despite well conducted antibiotherapy. Conclusion: RSIE is rare and occurs in a wide range of underlying conditions like implantable electronic devices, indwelling catheters, CHD and immune compromised state. Surprisingly, it can occur in young individuals without known risk factors. In our context, rheumatic heart disease remains the most incriminated etiology which lead us to question three essential points: 1. The interest of antibiotic prophylaxis in young patients with VSDs 2. The use of empiric antibiotics with action against streptococcus 3. Early surgical treatment in rheumatic heart disease.

scholarly journals A study of clinical and etiological profile of infective endocarditis and its correlation with echocardiography in patients of rheumatic heart disease

2017 ◽  
Vol 4 (5) ◽  
pp. 1323
Author(s):  
Achyut Sarkar ◽  
Prashant Kumar ◽  
Somnath Mukherjee ◽  
Anurag Passi ◽  
Jitendra Kumar Singh
Keyword(s):  
Heart Disease ◽  
Infective Endocarditis ◽  
Blood Culture ◽  
Rheumatic Heart Disease ◽  
Local Population ◽  
Penicillin G ◽  
Sensitivity Pattern ◽  
Moderate Anemia ◽  
The Mean ◽  
Rheumatic Heart

Background: This observational study was to determine the offending microorganisms and clinical profile of infective endocarditis in rheumatic heart disease patients in local population of Jharkhand, the response of disease to medical treatment and to evaluate the prognosis of the cases.Methods: 25 cases of Rheumatic heart disease, fulfilling the diagnostic criteria for infective endocarditis were studied prospectively with baseline investigations, blood culture and echocardiography and were treated with appropriate antibiotics.Results: In this study, the mean age observed was 26 year and male patient to female patient ratio was 3.16:1. Aortic valve was the commonest valve to be involved. Cardiac murmurs were present in all patients, splenomegaly was present in 56% of patients but peripheral signs of infective endocarditis were rare. Blood culture was positive in 28% of cases and staphylococcus aureus was the main organism isolated. 23 cases out of 25 cases studied showed vegetations on echocardiography mostly on aortic or mitral valve. In majority of patients (80%) injection Penicillin G and Gentamicin were started in standard recommended dose first on empirical basis but later on suitable antibiotics were started according to sensitivity pattern. Mortality was significantly high (20%).Conclusions: Fever and constitutional symptoms were the most common presentation. Mild to moderate anemia, leucocytosis, high ESR were very common but, peripheral signs were rarely observed in our study. Staphylococcus was the predominant etiological agent and treatment of endocarditis was more successful when suitable antibiotics were started after culture and sensitivity.

Fatal Coronary Embolism in Infective Endocarditis Associated with Chronic Rheumatic Heart Disease: An Unexpected Transesophageal Echocardiographic Documentation

2009 ◽  
Vol 26 (7) ◽  
pp. 870-872 ◽  
Author(s):  
Manjunath Cholenahalli Nanjappa ◽  
Ravindranath Khandenahalli Shankarappa ◽  
Dhanalakshmi Chandrasekaran ◽  
Nagaraja Moorthy
Keyword(s):  
Heart Disease ◽  
Infective Endocarditis ◽  
Rheumatic Heart Disease ◽  
Coronary Embolism ◽  
Rheumatic Heart
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