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Infective endocarditis in patients with congenitally malformed hearts: characterization of the syndrome in a developing country

Published online by Cambridge University Press:  24 October 2007

Bilal K. Siddiqui ,
Muhammed Tariq ,
Atif Jadoon ,
Ghulam Murtaza ,
Asim Syed ,
M. Bilal Abid ,
Maria Qamaruddin ,
Mehnaz Atiq  and
Raymond A. Smego
Bilal K. Siddiqui*
Affiliation:
Department of Medicine, Aga Khan University, Karachi, Pakistan
Muhammed Tariq
Affiliation:
Department of Medicine, Aga Khan University, Karachi, Pakistan
Atif Jadoon
Affiliation:
Department of Medicine, Aga Khan University, Karachi, Pakistan
Ghulam Murtaza
Affiliation:
Department of Medicine, Aga Khan University, Karachi, Pakistan
Asim Syed
Affiliation:
Department of Medicine, Aga Khan University, Karachi, Pakistan
M. Bilal Abid
Affiliation:
Department of Medicine, Aga Khan University, Karachi, Pakistan
Maria Qamaruddin
Affiliation:
Department of Medicine, Aga Khan University, Karachi, Pakistan
Mehnaz Atiq
Affiliation:
Department of Medicine, Aga Khan University, Karachi, Pakistan
Raymond A. Smego
Affiliation:
Department of Medicine, Aga Khan University, Karachi, Pakistan
*
Correspondence to: Bilal K. Siddiqui MD, Long Island Jewish Medical Center, 270-05 76th Avenue, New Hyde Park, NY 11580. Tel: 1 718 470 7270; Fax: 1 718 470 0827; E-mail: [email protected]
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Abstract

Objective

Cardiac surgery for correction or palliation of congenital cardiac disease in infancy and childhood remains a privilege that is rarely accessible to two-thirds of the world’s population. This imbalance has created a unique spectrum of illness in patients with underlying congenital cardiac disease and complicating infective endocarditis in developing countries, including Pakistan. In this study, we characterize endocarditis as seen in such patients presenting in Karachi.

Patients and settings

We reviewed retrospectively patients admitted to Aga Khan University with underlying congenitally malformed hearts and endocarditis between 1991 and 2004.

Results

We identified 48 patients with endocarditis according to the modified Duke Criterions, with just over half the cases (54%) classified as definite endocarditis. Of the patients, 23 (49%) patients were more than 16 years old. Uncorrected left-to-right-shunts, tetralogy of Fallot, and congenital mitral valvar disease were the most common underlying defects. Patients with cyanotic defects, particularly of the complex type, were underrepresented (4%). Only 11 (22.9%) of the patients had a previous palliative or corrective surgery. In one-third of the patients (16), streptococcal species were identified as the microbiologic cause of endocarditis, and 22 (45.8%) had culture-negative endocarditis. In contrast, Staphylococcus aureus and enterococci caused endocarditis in only one patient each. There were no differences in mortality or complications between cyanotic and acyanotic congenital defects. Surgery was performed in nine (18.7%) patients with endocarditis, and of these, 13 (27.1%) died.

Conclusions

In contrast to the developed world, endocarditis in the developing countries, such as Pakistan, complicates uncorrected left-to-right shunts and tetralogy of Fallot, probably because patients with complex cyanotic defects fail to survive long after birth due to the lack of available surgery. Almost half of patients had culture-negative endocarditis, likely related to several factors.

Keywords

Endocarditiscyanotic heart defectsacyanotic heart defectsuncorrected congenital heart disease
Type
Original Article
Information
Cardiology in the Young , Volume 17 , Issue 6 , December 2007 , pp. 623 - 630
Copyright
Copyright © Cambridge University Press 2007

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References

1. Hoffman, JI, Christianson, R. Congenital heart disease in a cohort of 19,502 births with long-term follow-up. Am J Cardiol 1978; 42: 641–647.CrossRefGoogle Scholar
2. Korzeniowski, OM, Kaye, D. Infective endocarditis. In: Braunwald, E. (ed). Heart disease: a textbook of cardiovascular medicine. Saunders, Philadelphia, 1992, pp 1078–1105.Google Scholar
3. Van der Meer, JT, Thompson, J, Valkenburg, HA, Michel, MF. Epidemiology of bacterial endocarditis in The Netherlands. II. Antecedent procedures and use of prophylaxis. Arch Intern Med 1992; 152: 1869–1873.CrossRefGoogle ScholarPubMed
4. McKinsey, DS, Ratts, TE, Bisno, AL. Underlying cardiac lesions in adults with infective endocarditis. The changing spectrum. Am J Med 1987; 82: 681–688.CrossRefGoogle ScholarPubMed
5. Li, JS, Sexton, DJ, Mick, N, et al. . Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis 2000; 30: 633–638.CrossRefGoogle Scholar
6. Ahmed, IP. A serological investigation of Q fever in Pakistan. J Pak Med Assoc 1987; 37: 126–129.Google ScholarPubMed
7. Servino, V, Assuma, M, De Dominicis, A. Serum antibodies against adenoviruses, reoviruses and Coxiella burnetii in subjects of Swat (northwestern Pakistan). Arch Ital Sci Med Trop Parassitol 1968; 49: 237–242.Google ScholarPubMed
8. Qazilbash, AA, Bari, A. Sero-diagnosis of human brucellosis among TB suspected patients. J Pak Med Assoc 1997; 47: 243–246.Google ScholarPubMed
9. Martin, JM, Neches, WH, Wald, ER. Infective endocarditis: 35 years of experience at a children’s hospital. Clin Infect Dis 1997; 24: 669–675.CrossRefGoogle ScholarPubMed
10. Johnson, DH, Rosenthal, A, Nadas, AS. A forty-year review of bacterial endocarditis in infancy and childhood. Circulation 1975; 51: 581–588.CrossRefGoogle ScholarPubMed
11. Hoffman, JI, Kaplan, S. The incidence of congenital heart disease. J Am Coll Cardiol 2002; 39: 1890–1900.CrossRefGoogle ScholarPubMed
12. Dhawan, A, Grover, A, Marwaha, RK, et al. . Infective endocarditis in children: profile in a developing country. Ann Trop Paediatr 1993; 13: 189–194.CrossRefGoogle ScholarPubMed
13. Bitar, FF, Jawdi, RA, Dbaibo, GS, Yunis, KA, Gharzeddine, W, Obeid, M. Paediatric infective endocarditis: 19-year experience at a tertiary care hospital in a developing country. Acta Paediatr 2000; 89: 427–430.CrossRefGoogle Scholar
14. Ifere, OA, Masokano, KA. Infective endocarditis in children in the Guinea savannah of Nigeria. Ann Trop Paediatr 1991; 11: 233–240.CrossRefGoogle ScholarPubMed
15. Chen, SC, Hsieh, KS, Wang, YJ, Chen, YJ, Chi, CS. Infective endocarditis in infants and children during the past ten years. Zhonghua Yi Xue Za Zhi (Taipei) 1994; 53: 109–115.Google ScholarPubMed
16. Paganini, H, Firpo, V, Villa, A, et al. . Clinical study and analysis of risk factors for mortality in 86 cases of infectious endocarditis in children and adolescents in Argentina: 1988-2000. Enferm Infecc Microbiol Clin 2004; 22: 455–461.CrossRefGoogle ScholarPubMed
17. Lertsapcharoen, P, Khongphatthanayothin, A, Chotivittayatarakorn, P, Thisyakorn, C, Pathmanand, C, Sueblinvong, V. Infective endocarditis in pediatric patients: an eighteen-year experience from King Chulalongkorn Memorial Hospital. J Med Assoc Thai 2005; 88 (4 Suppl): S12–S16.Google ScholarPubMed
18. Bassili, A, Mokhtar, SA, Dabous, NI, Zaher, SR, Mokhtar, MM, Zaki, A. Congenital heart disease among school children in Alexandria, Egypt: an overview on prevalence and relative frequencies. J Trop Pediatr 2000; 46: 357–362.CrossRefGoogle ScholarPubMed
19. Khongphatthanayothin, A, Layangool, T, Sittiwangkul, R, Pongprot, Y, Lertsapcharoen, P, Mokarapong, P. Pediatric heart surgery waiting time in Thailand and its effect on mortality: A cooperative study from Chulalongkorn, Children and Chiang Mai University hospitals. J Med Assoc Thai 2005; 88 (4 Suppl): S23–S29.Google Scholar
20. Asou, T, Rachmat, J. Pediatric cardiac surgery in Indonesia. Cardiol Young 1998; 8: 437–439.CrossRefGoogle ScholarPubMed
21. Saxena, A. Congenital heart disease in India: a status report. Indian J Pediatr 2005; 72: 595–598.CrossRefGoogle ScholarPubMed
22. Morris, CD, Reller, MD, Menashe, VD. Thirty-year incidence of infective endocarditis after surgery for congenital heart defect. JAMA 1998; 279: 599–603.CrossRefGoogle ScholarPubMed
23. Geva, T, Frand, M. Infective endocarditis in children with congenital heart disease: the changing spectrum, 1965-85. Eur Heart J 1988; 9: 1244–1249.CrossRefGoogle ScholarPubMed
24. Bhat, AW, Jalal, S, John, V, Bhat, AM. Infective endocarditis in infants and children. Indian J Pediatr 1996; 63: 204–209.CrossRefGoogle ScholarPubMed
25. Sadiq, M, Nazir, M, Sheikh, SA. Infective endocarditis in children – incidence, pattern, diagnosis and management in a developing country. Int J Cardiol 2001; 78: 175–182.CrossRefGoogle ScholarPubMed
26. Van der Meer, JT, Thompson, J, Valkenburg, HA, Michel, MF. Epidemiology of bacterial endocarditis in The Netherlands. I. Patient characteristics. Arch Intern Med 1992; 152: 1863–1868.CrossRefGoogle ScholarPubMed
27. De Gevigney, D, Pop, C, Delahaye, JP. The risk of infective endocarditis after cardiac surgical and interventional procedures. Eur Heart J 1995; 16 (B Suppl): 7–14.CrossRefGoogle ScholarPubMed
28. Sadiq, M, Latif, F, Ur-Rehman, A. Analysis of infective endarteritis in patent ductus arteriosus. Am J Cardiol 2004; 93: 513–515.CrossRefGoogle ScholarPubMed
29. Campbell, M. Natural history of persistent ductus arteriosus. Br Heart J 1968; 30: 4–13.CrossRefGoogle ScholarPubMed
30. Balzer, DT, Spray, TL, McMullin, DO, Cottingham, WDO, Canter, CE. Endarteritis associated with a clinically silent patent arterial ductus arteriosus. Am Heart J 1993; 125: 1192–1193.CrossRefGoogle Scholar
31. Lamas, CC, Eykyn, SJ. Bicuspid aortic valve – a silent danger: analysis of 50 cases of infective endocarditis. Clin Infect Dis 2000; 30: 336–341.CrossRefGoogle ScholarPubMed
32. Choudhury, R, Grover, A, Varma, J, et al. . Active infective endocarditis observed in an Indian hospital 1981–1991. Am J Cardiol 1992; 70: 1453–1458.CrossRefGoogle Scholar
33. Roberts, WC. The congenitally bicuspid aortic valve: a study of 85 autopsy cases. Am J Cardiol 1970; 26: 72–83.CrossRefGoogle ScholarPubMed
34. Li, W, Somerville, J. Infective endocarditis in the grown-up congenital (GUCH) population. Eur Heart J 1998; 19: 166–173.CrossRefGoogle ScholarPubMed
35. Prendergast, BD. The changing face of infective endocarditis. Heart 2006; 92: 879–885.CrossRefGoogle ScholarPubMed
36. Bouza, E, Menasalvas, A, Munoz, P, Vasallo, FJ, del Mar Moreno, M, Garcia Fernandez, MA. Infective endocarditis: a prospective study at the end of the twentieth century – new predisposing conditions, new etiologic agents, and still a high mortality. Medicine (Baltimore) 2001; 80: 298–307.CrossRefGoogle ScholarPubMed