Characteristics of infective endocarditis in a developing country-clinical profile and outcome in 192 Indian patients, 1992–2001
Introduction
More than a century after Osler's first comprehensive description [1] and more than half a century after the discovery of penicillin and sulfonamides, infective endocarditis (IE) remains a serious cardiac problem in our country despite the availability of improved diagnostic and therapeutic facilities. Recent studies from the west have shown remarkable changes in the spectrum of IE [2], [3], [4], [5], [6], [7]. These changes are attributable to changes in substrate population, introduction of more accurate diagnostic criteria (Duke criteria), better diagnostic facilities, availability of a range of antibiotics and aggressive surgical approach. Published reports regarding IE are rather scanty from this part of the world [8], [9], [10], [11], [12], [13] and there is no large series from any centre involved in active and aggressive cardiac interventions and surgery. Given the scenario of changing trends and scanty data, an insight into the clinical expression and a comparison with western data is warranted. In this report we describe our experience of IE during last 10 years, its comparison with the western data and evaluation of risk factors for the adverse outcome.
Section snippets
Material and methods
Data were collected on a retrospective basis from the clinical records of all the patients who were admitted in our hospital with the diagnosis of IE from January 1992 to December 2001. Our hospital is a superspecialty tertiary care referral hospital. Only patients who met the Duke “definitive” criteria for IE [3] were included. Data from clinical presentation, investigative work up and outcome was compiled and analyzed. Investigative work up in all patients included haemogram, urine
Results
A total of 192 patients with 198 episodes of IE admitted in our hospital between January 1992 to December 2001 met Duke ‘definite’ criteria and formed the study population. There were 141 male and 51 female patients. The mean age was 27.6±12.7 years (range 4–68 years). There were 31 (16.1%) patients under 15 years while only 45 (23.5%) patients were above 40 years of age. According to Duke criteria, majority of episodes was clinically definite (78.8%) while rest was pathologically definite
Discussion
Infective endocarditis remains an important cause of morbidity and mortality among cardiac patients today. The reported studies of IE from this part of the world are very few [8], [9], [10], [11], [12], [13] and those too have not used the modern diagnostic and therapeutic modalities. So, the spectrum and outcome described in those studies does not represent the true picture of IE. Our study was planned keeping in view the limitation of earlier studies:
- (a)
Duke criteria were applied for diagnosis
Conclusions
Spectrum of IE in our country is different from the west, but quite similar as reported from developed countries about 40 years ago. It occurs in relatively younger population. RHD is the commonest underlying heart disease. IE in MVP, degenerative heart disease and intravenous drug abusers is uncommonly seen. Streptococci are still the commonest microorganisms responsible for IE. It still has high morbidity and mortality. CHF, renal failure and prosthetic valve dysfunction are independent
References (35)
Changing pattern of infective endocarditis
Am. J. Med.
(1985)- et al.
Duke endocarditis service. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings
Am. J. Med.
(1994) - et al.
Underlying cardiac lesion in adults with infective endocarditis: the challenging spectrum
Am. J. Med.
(1987) - et al.
The changing pattern of infective endocarditis in childhood
Am. J. Cardiol.
(1991) - et al.
Infective endocarditis, 1983–1988: echocardiographic findings and factors influencing morbidity and mortality
J. Am. Coll. Cardiol.
(1990) - W. Osler, The Gustonian lectures on malignant endocarditis. BMJ 1 (1885) 467–70, 522–6,...
- et al.
Infective endocarditis: clinical spectrum, presentation and outcome, An analysis of 212 cases 1980–1995
Heart
(2000) - et al.
Characteristics of infective endocarditis in France in 1991—a 1 year survey
Eur. Heart J.
(1995) - et al.
The microbiology and pathogenesis of infective endocarditis
Br. Heart J.
(1983) - et al.
Active infective endocarditis observed in an Indian hospital 1981–1991
Am. J. Cardiol.
(1992)
Clinical and bacteriological studies in infective endocarditis
Indian Heart J.
Bacterial endocarditis—its diagnostic problems
J. Assoc. Physicians India
Clinical spectrum of infective endocarditis: 15 years experience
Indian Heart J.
Infective endocarditis at autopsy in Northern India—a study of 120 cases
Jpn. Heart J.
Changing spectrum of clinical and laboratory profile of infective endocarditis
J. Assoc. Physicians India
Fungal endocarditis
Eur. Heart J.
Echocardiography predicts embolic events in infective endocarditis
J. Am. Coll. Cardiol.
Cited by (97)
Changing spectrum of infective endocarditis in India: An 11-year experience from an academic hospital in North India
2021, Indian Heart JournalCitation Excerpt :The polymicrobial group was more likely to have infections from S. aureus, CoNS, Candida, GNB, and enterococci. The relative contributions of GNB and fungi showed no significant variation over time.15–22 P. aeruginosa remained next common to S. aureus in IUD-IE.
Clinical characteristics and outcome of infective endocarditis among intravenous drug abusers in India
2020, Indian Heart JournalComplications of Rheumatic Heart Disease and Acute Emergencies
2020, Acute Rheumatic Fever and Rheumatic Heart DiseaseEpidemiology of heart valve disease
2019, Principles of Heart Valve EngineeringPediatric Infective Endocarditis and Stroke: A 13-Year Single-Center Review
2019, Pediatric Neurology