Abstract
IntroductionInfective endocarditis is an infection of the endocardial lining of the heart mainly associated with congenital and rheumatic heart disease. Although it is a rare disease in children, it is associated with high morbidity and mortality; death due to infective endocarditis has been reported to be as high as 26% in sub-Saharan Africa.MethodsThis was a retrospective review of routinely collected data from patient records.ResultsA total of 40 children (71% female) with 41 episodes of infective endocarditis admitted to a general paediatric ward in Addis Ababa, Ethiopia between 2008 and 2013. Age ranged from 7 months to 14 years, with a median of 9 years (Inter quartile Range: 7-12 years). Rheumatic and congenital heart diseases were underlying risk factors in 49% and 51% of cases respectively. Congestive heart failure, systemic embolization and death occurred in 66%, 12% and 7.3% respectively. Death was associated with the occurrence of systemic embolization (P-value = 0.03).ConclusionRheumatic heart disease was an important predisposing factor for infective endocarditis in Ethiopian children. Late presentations of cases were evidenced by high proportion of complications such as congestive heart failure. A low rate of clinically evident systemic embolization in this study may be a reflection of the diagnostic challenges. High proportion of prior antibiotic intake might explain the cause of significant BCNE. Preventive measures like primary and secondary prophylaxis of rheumatic fever may decrease the associated morbidity and mortality. Early detection and referral of cases, awareness creation about indiscriminate use of antimicrobials, and proper history taking and documentation of information recommended.
Highlights
Infective endocarditis (IE) is an infection of the internal layer of the heart chambers
In this study we reported on a cohort of 41 episodes of IE in 40 children with infective endocarditis (IE) admitted to a general paediatric ward in Addis Ababa between 2008 and 2013
Our study showed that rheumatic heart disease is still prevalent in our setting, indicating the necessary preventive measures to decrease the incidence of IE
Summary
Infective endocarditis (IE) is an infection of the internal layer of the heart chambers It is rare but incidence may be increasing in children [1]. It is associated with high morbidity and mortality. It occurs with underlying rheumatic and congenital heart disease. Congenital heart disease is more common cause of IE in high income countries [1,2]. Studies have shown that there is a continuous bacteremia and high rate of positive blood culture in infective endocarditis. Studies have shown in a report from low and middle income countries that, blood culture negative endocarditis (BCNE) is in the range of 21-67% [8]. In this paper we describe the clinical profile, treatment outcomes and diagnostic challenges of 41 episodes of IE in 40 paediatric patients admitted and diagnosed by modified Dukes criteria
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