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.
Pericarditis is a rare manifestation of tuberculosis. We report the case of a 35-year-old woman admitted for clinical tamponade. The echocardiogram revealed a pericardial effusion of great circumferential abundance with significant respiratory variations and a bilateral pleural effusion of average abundance on chest Xray. The patient underwent emergency pericardial drainage. The initial tuberculosis assessment was negative. The culture of the liquid was positive after 8 days Revealing Rifampicin-Resistant tuberculosis (RR-TB). Therefore, examination of the pericardial fluid is useful in the diagnosis of pericarditis due to RR-TB. The patient was put on a special treatment regimen after consensus, which yielded satisfactory clinical improvement. Our findings suggest that though pericardial tuberculosis remains a rare disease, it is important to consider it as an etiological diagnosis, especially in endemic countries because it's poor therapeutic prognosis. Early diagnosis would allow better management of these cases in order to limit cases of resistance.
Introduction:The hydatid cyst of the heart is rare. It is a characterized by a large clinical and paraclinical polymorphism. Our objective is to illustrate through this observation the interest of screening for the cardiac localization of this affection in all patients suspected or suffering from hydatidosis.Observation: We report the clinical case of a 47-year-old patient operated 11 years ago for two rights and left pulmonary Hydatid cysts presenting for chronic left upper abdominal and lower thoracic pain accentuated 24h before his admission and in whom the clinical examination is without particularity. CT-scan shows mass 4.9x5.2x6.2cm in inter-cardio-diaphragmatic with a thick, irregular wall reaching the left lung and contacting the lower surface of the LV and the diaphragm with loss of the interface separation with presence of calcifications. Echocardiography confirmed the presence of a heterogeneous solido-cystic mass adherent to the inferior surface of the left ventricular with presence of calcifications. The evolution was marked by the emptying of the pre-existing left cardio-phrenic cystic formation with disappearance of the cystic component and persistence of calcification peripheral to the control scan performed 2 months later making the MRI analysis difficult. The hydatid serology is Negative outcome and the diagnosis of reshaped cardiac hydatid cyst was retained given the patient's history, the evolution of the lesions and the therapeutic abstention under strict supervision was indicated. Conclusion:This observation illustrates the interest of the systematic screening of the heart localization in any patient with or suspected of hydatidosis.
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