Clinical Profile and Outcome of Infective Endocarditis patients admitted in tertiary care center in eastern part of Nepal

Abstract

Introduction: Data regarding the pattern and outcome of infective endocarditis from developing countries are sparse and there have been few studies in our part of the world understanding the clinical profile and outcome of patients with infective endocarditis.

Methods: It was a hospital based descriptive retrospective cross-sectional with the objective on clinical profile and outcome of infective endocarditis patients admitted in tertiary care center in eastem part of Nepal. The study included cases admitted in department of internal medicine ward, BPKIHS with diagnosis of infective endocarditis from year 2008 to 2015.

Results: A total of 20 patients were diagnosed as case of infective endocarditis during the period from 2008 to 2015 in department of internal medicine. The median age of study group was 31 years (range 14-56). Male to female ratio was 9:1. Among various risk factors, history of Intravenous drug use was the main risk factor present in 50% of patients, followed by definite rheumatic heart disease in 40% of study population. Fever, Chills and sweats were main symptom present in all patients anemia in 90 %, heart murmur in 80%, anorexia in 45%, myalgia in 35%, splenomegaly in 15%, neurological manifestation, clubbing, Roth's s and embolic phenomenon in 5% of patients. The most common valve involved was tricuspid valve, present in 50% patient, followed by mitral valve in 35% patient and aortic valve in 15% of patients. Anemia was most common laboratory abnormalities present in 90% of the patients followed by leukocytosis in 80% of patients, microscopic hematuria and disarranged renal function test was present in 40% of the patients. Blood culture positivity was seen in 30% of cases and the pathogen isolated was Staphylococcus aureus. Prior antibiotic treatment was received by 40% of patients. Acute Renal failure was the main complication appeared which was present in 25% of patients followed by Neurological manifestations in 5% and peripheral embolic phenomenon was present 5% of patients.

Conclusion: The spectrum of our infective endocarditis patients differ from those seen in the west in terms of epidemiology, predisposing factors, microbiology, complications, and outcome. Fever, pallor and heart murmur were most common symptoms and acute renal failure was the most common complication. Majority of our patients improve despite having lack of surgical backup. Culture-negative endocarditis continues to have a high prevalence in developing countries like Nepal, largely due to prior antibiotic use before clinical presentation.