Epidemiological, clinical and microbiological features of right-sided endocarditis: A Tunisian experience

Abstract

Right-sided infective endocarditis RSIE is considered as a differential diagnosis of patients with febrile syndrome, respiratory signs and predisposing factors. It concerns mainly patients with a history of intravenous drug use (IVDU) or who have a pacemaker or other intracardiac device. The clinical presentation and treatment are different from those of left-sided endocarditis and the prognosis is more favorable, as many patients can be cured with medical treatment alone. To determine epidemiological, clinical and microbiological characteristics of RSIE in a Tunisian cohort. This was a prospective study which included patients diagnosed with infective endocarditis (IE) and hospitalized in the cardiology department of Monastir hospital between 1983 and 2017. We included patients who were diagnosed with definite infective endocarditis based on the modified Ducke criteria. Two hundred forty patients were diagnosed with IE and showed vegetations on cross-sectional echocardiography. In 31 (12.9%) patients, only the right side of the heart was involved: specifically the tricuspid valve alone or associated with pulmonary valves or the right ventricular outflow tract or free wall in 29, and pulmonary valve alone in 2. Fourteen patients (51.6%) had underlying congenital heart disease, 7 had intravascular device whereas the remaining 10 patients (48.4%) did not have any underlying heart disease. The latter group, had isolated right-sided infective endocarditis. The diagnosis can be dramatically delayed, since right-sided murmurs often go undetected, Staphylococcus aureus SA was the most common organism with a high rate mortality. Most of IE are resolved conservatively by antibiotics and surgery is only indicated in particular cases. We conclude that, like western reports, the pattern of right-sided infective endocarditis in Tunisia is almost the same; IVDU was the commonest cause and the SA was the most frequent pathogen.