Les endocardites infectieuses chez l’enfant africain subsaharien, étude transversale à propos de 19 cas à Ouagadougou au Burkina Faso

Abstract

IntroductionInfective endocarditis is a transplant of a microorganism on a most often injured endocardium. It is rare in children. This work aimed to determine the frequency of endocarditis of the child, to describe clinical presentation, data from echocardiography, microbiological profile and clinical course. Patients and methodsFrom May 1 2010 to April 30 2011, we consecutively included children received for infective endocarditis in two medical centers in the city of Ouagadougou: Saint-Camille medical center and teaching hospital Yalgado-Ouedraogo. We investigated the functional and general signs and treatment already received. The physical examination looking for an infectious syndrome, pneumonia, heart failure and entrance doors. Blood cultures, blood count, creatinine, blood chemistry, HIV status, electrocardiogram, chest radiography and cardiac Doppler ultrasound were systematic. The diagnosis of the disease was based on Duke criteria. ResultsNineteen endocarditis in children were reported, that is 1.7% of admissions. The average age was 4.7±2.6 years (extremes: 1 and 14). The sex ratio was 1.7 for girls. The clinical presentation was a common infectious syndrome. Impaired general condition and congestive heart failure were present on admission in six cases, respectively. The front door was dental in nine cases (47.4%), skin in four cases (21%) and ENT in three cases (15.8%). A peripheral vein was implicated in one case. In the two other cases, no front door had been found. HIV serology was positive in four cases. As for the blood cultures, they were positive in 13 cases. The germs found were Streptococcus in 10 cases and staphylococcus in three cases. Echocardiography had revealed vegetations in 18 cases. These vegetations were localized on the mitral in nine cases. Multiple locations were found in four cases. Underlying heart disease was dominated by rheumatic valve disease (68.4%), healthy heart forms were found in two cases. Treatment consisted of antibiotics, antipyretic treatment and that of heart failure as appropriate. The evolution was marked by five deaths (26.3%) in an array of septic shock. Death was more important in congenital heart disease. ConclusionInfective endocarditis of the child is common in our practice. The clinical syndrome is common infectious. Streptococcus and Staphylococcus are the two germs found. The main door is dental. Hence, dental care should be promoted for better prevention of infective endocarditis in our context.