Clinical profile and outcome of children admitted with infective endocarditic at Tikur Anbessa Specialized Hospital

Abstract

Back ground: Infective endocarditis (IE) is an infection of the endocardial surface of the heart. Infective endocarditis is associated with substantial morbidity and mortality. The diagnosis of IE is based upon a careful history and physical examination, blood culture and laboratory results, an electrocardiogram, a chest radiograph, and an echocardiogram. Several sets of criteria for IE have been described. The most commonly accepted are the Duke criteria.
Objective: To study clinical features and etiologic agents, treatment and mortality of children admitted in the hospital with infective endocarditis. To study the predisposing or risk factor and isolated organism in blood culture for infective endocarditis.
Methodology: A retrospective analysis was conducted on the hospital medical records of pediatric patients under 15 years with the discharge diagnosis of IE who were admitted to Tikur Anbessa Specialized hospital between September 2005 and August 2009
Result: There were 66 episodes of infective endocarditis 20/63 (32%) were male and 43/63(68%) were female. The ages ranged from 4 to 168 months. Thirty eight (60.3%) of them had underlying chronic rheumatic valvular heart disease and 24(38.1%) had Congenital heart disease. Clinical presentations included: fever, pallor, congestive heart failure, Splenomegaly, clubbing, renal complication and neurological findings. Laboratory findings include: A haematocrit of less than 10mg/dl, Leukocytosis >12,000, Erythrocyte sedimentation rate >30mm/hr s, hematuria, blood culture was positive only in 18 episodes of IE (27.3%). Coagulase negative staphylococcus aureus and staphylococcus aureus were the two most commonly isolated bacteria. Transthoracic Echocardiography was done in 58/66 (87.9%) episodes. Vegetation was found in 31(53.4%) of the Echocardiography done and one non- oscillating thrombus. Ampicilline, cloxacilline and gentamycin was used to treat 31(37.9%) episodes of IE. Twenty five (37.9%) were treated for 4 weeks. Fifty-four patients (81.8%) survived. There were 5 deaths and overall mortality was 7.6%. Patients died during therapy (cause of death; were thromboembolism, sudden death, cardio respiratory failure 20 to massive pericardial effusion and acute renal failure. Seven (10.6%) patients went against medical advice before completing their treatment.
Conclusion: This study describes the presentation, treatment and outcome of IE in Tikur Anbessa hospital. Infective endocarditis remains a challenging problem. Chronic rheumatic heart disease remains to be the major predisposing factor. Culture negative infective endocarditis still represents larger proportion of our patients. In addition to cross sectional echocardiography, additional clinical and laboratory parameters are required to make the diagnosis. Penicillin and gentamycin are still important drugs. Cloxacilline can be added if staphylococcus is strongly suspected. Embolic episodes are still important cause of high mortality and morbidity.