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Retrospective analysis of 97 patients with infective endocarditis seen over the past 8 years
Abstract:
The medical records of 97 consecutive patients (101 episodes) of infective endocarditis seen from January 1979 through January 1987 were reviewed. Only 30% of the patients were over 50 years of age and the majority (69%) of infecting organisms were streptococci (mainly of the viridans group), which were similar to those reported from the West in the early antibiotic era. Pseudomonas organisms and enterococci accounted for 6% and 5%, respectively. Fungal infections were noted in 2 patients. There was a high incidence (38%) of predisposing rheumatic valvular disease; approximately half of these patients had prosthetic valve infections. Mitral valve prolapse was also an important predisposing disease (11%). One-third (34%) of the patients had febrile illness for longer than 8 weeks before the diagnosis was established. The hospital morality rate was 22%; cerebral embolism and ruptured mycotic aneurysm, congestive heart failure, and sudden death were the major causes of death. Echocardiography disclosed vegetations on the cardiac valves and preexisting lesions in 75% of the episodes. Early recognition and proper treatment should be the focus of efforts to reduce mortality from infective endocarditis.
Insights
Infective endocarditis in this study was predominantly caused by streptococci, with rheumatic heart disease being a common predisposing factor. Early diagnosis and treatment are crucial for reducing the high mortality rate associated with this serious heart infection.
Area of Science:
- Cardiology
- Infectious Diseases
- Internal Medicine
Background:
- Infective endocarditis (IE) is a serious infection affecting the heart valves.
- Understanding the epidemiology and risk factors of IE is crucial for effective management.
- Previous studies have focused on Western populations during the early antibiotic era.
Purpose of the Study:
- To review the clinical characteristics, causative organisms, predisposing factors, and outcomes of infective endocarditis.
- To identify key factors influencing mortality in IE patients.
- To highlight the role of echocardiography in diagnosing IE.
Main Methods:
- Retrospective review of medical records from 97 patients (101 episodes) of infective endocarditis.
- Data collection included patient demographics, causative organisms, predisposing conditions, diagnostic methods, and mortality causes.
- Analysis of echocardiographic findings for vegetations and cardiac lesions.
Main Results:
- The majority of patients (69%) were infected with streptococci; rheumatic valvular disease (38%) and mitral valve prolapse (11%) were significant predisposing factors.
- A high incidence of delayed diagnosis (34% with illness >8 weeks) was observed.
- The hospital mortality rate was 22%, with cerebral embolism and congestive heart failure being major causes of death. Echocardiography detected vegetations in 75% of episodes.
Conclusions:
- Streptococci remain a primary cause of infective endocarditis, often associated with rheumatic heart disease.
- Delayed diagnosis and treatment contribute to high mortality rates.
- Early recognition and prompt management, aided by echocardiography, are essential to improve outcomes in infective endocarditis.