Infective endocarditis in infants and children in the Western Cape, South Africa: a retrospective analysis

Abstract

Infective endocarditis is a microbial infection of the endothelial surface of the heart, predominantly the heart valves, that is associated with high mortality and morbidity. Few contemporary data exist regarding affected children in our context.Aims and Objectives:We aimed to describe the profile and treatment outcomes of infant and childhood endocarditis at our facilities.Methods:This is a retrospective analysis of infants and children with endocarditis at two public sector hospitals in the Western Cape Province of South Africa over a 5-year period. Patients with “definite” and “possible” endocarditis according to Modified Duke Criteria were included in the review.Results:Forty-nine patients were identified for inclusion; 29 had congenital heart disease as a predisposing condition; 64% of patients met “definite” and 36% “possible” criteria. The in-hospital mortality rate was 20%; 53% of patients underwent surgery with a post-operative mortality rate of 7.7%. The median interval from diagnosis to surgery was 20 days (interquartile range, 9–47 days). Valve replacement occurred in 28% and valve repair in 58%. There was a significant reduction in valvular dysfunction in patients undergoing surgery and only a marginal improvement in patients treated medically. Overall, 43% of patients had some degree of residual valvular dysfunction.Conclusion:Endocarditis is a serious disease with a high in-hospital mortality and presents challenges in making an accurate diagnosis. Despite a significant reduction in valvular dysfunction, a portion of patients had residual valvular dysfunction. Early surgery is associated with a lower mortality rate, but a higher rate of valve replacement compared with delayed surgery.

Clinical and Echocardiographic Characteristics of Pediatric Infective Endocarditis and Predictors of Embolic Events: Experience from A Tertiary Center

“…Gram-positive cocci were the most common cause of IE in our study; however, the composition of pathogenic microorganisms differed signi cantly according to HD status. S. aureus was more common in non-HD patients with IE, consistent with some studies [19][20][21], and Streptococcus was most common in HD patients, as other studies showed [1]. In other studies, the frequency of S. aureus and Streptococcus was similar [22].…”

Epidemiology of infective endocarditis in Africa: a systematic review and meta-analysis

“…Outcome data were reported in 23 (55%) of 42 studies. [21][22][23][25][26][27][28][29][31][32][33]35,[40][41][42][45][46][47][48][49][50][51][52] The pooled in-hospital mortality rate across studies was 22•6% (95% CI 19•5-25•9), which was similar in studies from north Africa (22•5%) and those from sub-Saharan Africa (22•7%; figure 4). Heart failure was the most frequent complication, occurring in 47 5 and the appendix (pp 62-66).…”

“…22,[29][30][31]36,38,43 A microorganism was detected in 48 Twelve (29%) of 42 studies reported data for surgical treatment of infective endo carditis. [21][22][23]25,26,28,29,31,40,42,45,52 The rate of surgery uptake in studies from north Africa was 49•7% (95% CI 42•5-56•9), ranging from 30•2% to 64•6%, whereas the rate of surgery uptake in two studies from sub-Saharan Africa was 46•1% (39•0-53•4). The pooled rate of surgical treatment of infective endocarditis was 49•1% (95% CI 43•2-55•1; appendix p 56).…”

“…Three (7%) of 42 studies reported data specifically in children. [40][41][42] The mortality rate in the paediatric population was 15•9% (95% CI 6). Data for other predictors are summarised in the appendix (pp 12-13).…”

Infective endocarditis in children-pattern, diagnosis, management and short term outcome in Sudan

“…This study aimed to identify diagnosis, management and short outcome of IE at Ahmed Gasim Children's hospital; during the study period, 6260 patients were admitted,47 patients were identified to have IE according to Dukes criteria.Three patients fulfilled the criteria for Definite endocarditis and 44 were classified as Possible; 6 IE admission rate was 7.5: 1000 admission, this figure is high compared to other countries even in Africa, 8 a large multicentre study from USA from 2003 to 2010showed the annual incidence rate in the United States was 0.05-0.12 cases per 1000 paediatric admissions, 1 CHD has been associated with increased risk of periodontal infection and this in turn increased the risk of endocarditis in CHD cases. Previous studies from Ahmed Gasim hospital showed that Sudanese children with CHD are at increased risk of severe gingivitis and caries compared to the children without CHD.…”