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Pneumococcal endocarditis in Alaska natives. A population-based experience, 1978 through 1990.
J C Finley1, M Davidson, A J Parkinson
1Department of Medicine, Alaska Native Medical Center, Anchorage.
Archives of Internal Medicine
|August 1, 1992
Summary
Indigenous Alaska Natives experience severe Streptococcus pneumoniae infective endocarditis (IE), often requiring emergency surgery and resulting in high mortality. Prevention of pneumococcal disease in this population is crucial.
Area of Science:
- Infectious Diseases
- Cardiology
- Public Health
Background:
- Streptococcus pneumoniae is an uncommon cause of infective endocarditis (IE).
- Indigenous Alaska Natives (ANs) have high rates of invasive pneumococcal disease.
- This study investigated S. pneumoniae IE in ANs over 12.5 years.
Purpose of the Study:
- To describe the clinical presentation, microbiology, and outcomes of S. pneumoniae IE in ANs.
- To calculate incidence rates of S. pneumoniae IE and all IE in this population.
- To compare S. pneumoniae IE rates in ANs to other populations.
Main Methods:
- Review of medical records for nine confirmed cases of S. pneumoniae IE in ANs.
- Analysis of 56 IE cases in ANs from 1978-1990.
- Calculation of incidence rates for S. pneumoniae IE and all IE.
Main Results:
- S. pneumoniae IE in ANs is fulminant, causing aortic valve insufficiency (100%), meningitis (56%), and death (33%).
- Alcoholism was the most common underlying condition (56%); no patients had prior heart disease.
- Penicillin-sensitive S. pneumoniae isolates were from vaccine serotypes; IE accounted for 15.8% of all IE in ANs.
Conclusions:
- Pneumococcal endocarditis in ANs frequently necessitates emergent valve replacement and has a 33% mortality rate.
- The incidence of S. pneumoniae IE in ANs is 5-37 times higher than elsewhere.
- Enhanced pneumococcal disease prevention and clinical vigilance for IE in sepsis patients are recommended.