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

Published online by Cambridge University Press:  02 September 2019

Mark L. Willoughby Open the ORCID record for Mark L. Willoughby [Opens in a new window] ,
Wisdom Basera ,
Susan R. Perkins ,
George A. M. Comitis ,
Barend Fourie ,
John B. Lawrenson  and
Liesl J. Zühlke Open the ORCID record for Liesl J. Zühlke [Opens in a new window]
Mark L. Willoughby*
Affiliation:
Paediatric Cardiology Unit, Department of Paediatrics and Child Health, Faculty of Health Sciences, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
Wisdom Basera
Affiliation:
Paediatric Cardiology Unit, Department of Paediatrics and Child Health, Faculty of Health Sciences, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Susan R. Perkins
Affiliation:
Paediatric Cardiology Unit, Department of Paediatrics and Child Health, Faculty of Health Sciences, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
George A. M. Comitis
Affiliation:
Paediatric Cardiology Unit, Department of Paediatrics and Child Health, Faculty of Health Sciences, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
Barend Fourie
Affiliation:
Department of Paediatrics and Child Health, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
John B. Lawrenson
Affiliation:
Paediatric Cardiology Unit, Department of Paediatrics and Child Health, Faculty of Health Sciences, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa Department of Paediatrics and Child Health, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
Liesl J. Zühlke
Affiliation:
Paediatric Cardiology Unit, Department of Paediatrics and Child Health, Faculty of Health Sciences, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
*
Author for correspondence: Dr M. Willoughby, Department of Paediatrics and Child Health, Faculty of Health Sciences, Red Cross War Memorial Children’s Hospital, University of Cape Town, ICH Building, Room 2.17, Klipfontein Road, Rondebosch 7700, Cape Town, South Africa. Tel: +27 21 532 1836. E-mail: [email protected]
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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.

Keywords

Infective endocarditisendocarditisModified Duke Criteriavalvular dysfunctionvegetation
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 10 , October 2019 , pp. 1282 - 1286
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Copyright
© Cambridge University Press 2019 

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References

Ferrieri, P, Gewitz, MH, Gerber, MA, et al. Unique features of infective endocarditis in childhood. Circulation 2002; 105: 2115–2126.CrossRefGoogle ScholarPubMed
Sadiq, M, Nazir, M, Sheikh, SA. Infective endocarditis in children – incidence, pattern, diagnosis and management in a developing country. Int J Cardiol Heart Vasc 2001; 78: 175–182.CrossRefGoogle ScholarPubMed
Baltimore, RS, Gewitz, M, Baddour, LM, et al. Infective endocarditis in childhood: 2015 update: a scientific statement from the American Heart Association. Circulation 2015; 132: 1487–1515.CrossRefGoogle ScholarPubMed
Valente, AM, Jain, R, Scheurer, M, et al. Frequency of infective endocarditis among infants and children with Staphylococcus aureus bacteremia. Pediatrics 2005; 115: e15–e19.Google ScholarPubMed
Durack, DT, Lukes, AS, Bright, DK, Service, DE. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Am J Med Sci 1994; 96: 200–209.Google ScholarPubMed
Kang, D-H, Kim, Y-J, Kim, S-H, et al. Early surgery versus conventional treatment for infective endocarditis. N Engl J Med 2012; 366: 2466–2473.CrossRefGoogle ScholarPubMed
Shamszad, P, Khan, MS, Rossano, JW, Fraser, CD Jr. Early surgical therapy of infective endocarditis in children: a 15-year experience. J Thorac Cardiovasc Surg 2013; 146: 506–511.CrossRefGoogle ScholarPubMed
Nishimura, RA, Otto, CM, Bonow, RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2017; 70: 252–289.CrossRefGoogle Scholar
https://www.stata.com/manuals13/rsymmetry.pdf (accessed 24/08/2019)Google Scholar
http://www.statssa.gov.za/publications/P0318/P03182017.pdf (accessed 24/8/2019)Google Scholar
Hugo-Hamman, C, Md, Moor, Human, D. Infective endocarditis in South African children. J Trop Pediatr 1989; 35: 154–158.CrossRefGoogle ScholarPubMed
Penk, JS, Webb, CL, Shulman, ST, Anderson, EJ. Echocardiography in pediatric infective endocarditis. Pediatr Infect Dis J 2011; 30: 1109–1111.CrossRefGoogle ScholarPubMed
Evangelista, A, Gonzalez-Alujas, M. Echocardiography in infective endocarditis. Heart 2004; 90: 614–617.CrossRefGoogle ScholarPubMed
Tissieres, P, Gervaix, A, Beghetti, M, Jaeggi, ET. Value and limitations of the von Reyn, Duke, and modified Duke criteria for the diagnosis of infective endocarditis in children. Pediatrics 2003; 112: 1404–1404.CrossRefGoogle Scholar
Fournier, P-E, Thuny, F, Richet, H, et al. Comprehensive diagnostic strategy for blood culture-negative endocarditis: a prospective study of 819 new cases. Clin Infect Dis 2010; 51: 131–140.CrossRefGoogle ScholarPubMed
Dursun, M, Yılmaz, S, Yılmaz, E, et al. The utility of cardiac MRI in diagnosis of infective endocarditis: preliminary results. Diagn Interv Radiol 2015; 21: 28.CrossRefGoogle ScholarPubMed
Kelchtermans, J, Grossar, L, Eyskens, B, et al. Clinical characteristics of infective endocarditis in children. Pediatr Infect Dis J 2019; 38: 453–458.CrossRefGoogle ScholarPubMed
Habib, G, Lancellotti, P, Antunes, MJ, et al. 2015 ESC guidelines for the management of infective endocarditis: the task force for the management of infective endocarditis of the European Society of Cardiology (ESC) endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015; 36: 3075–3128.CrossRefGoogle Scholar
Jankelow, D, Cupido, B, Zühlke, L, et al. Prevention of infective endocarditis associated with dental interventions. SA Heart 2017; 14: 170–174.CrossRefGoogle Scholar
Chu, VH, Cabell, CH, Benjamin, DK Jr, et al. Early predictors of in-hospital death in infective endocarditis. Circulation 2004; 109: 1745–1749.CrossRefGoogle ScholarPubMed
Choudhary, SK, Talwar, S, Airan, B. Choice of prosthetic heart valve in a developing country. Heart Asia 2016; 8: 65–72.CrossRefGoogle ScholarPubMed