scholarly journals RIGHT SIDED ENDOCARDITIS: CASE SERIES FROM MOROCCO

2021 ◽  
Vol 9 (4) ◽  
pp. 704-714
Author(s):  
A. Laalou ◽  
◽  
A. Chachi ◽  
A. Benbahia ◽  
S. Jourani ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Surgical Treatment ◽  
Infective Endocarditis ◽  
Rheumatic Heart Disease ◽  
Pulmonary Valve ◽  
Indwelling Catheters ◽  
Cardiac Devices ◽  
Wide Range ◽  
Rheumatic Heart

Objective: Compared with the extensive data on left sided infective endocarditis, right-sided infective endocarditis (RSIE) remains a rare condition. It accounts for 5–10% of all cases of infective endocarditis (IE) [1] [2] [3].Although it is predominantly encountered in the injecting drug user (IDU) population, where HIV and HCV infections often coexist, rheumatic heart disease remains the most important predisposing factor for IE in our context. The aim our study is to report clinical, investigation, management and outcome data in 5 patients diagnosed with RSIE in our department during the last 2 years. Methods: A retrospective analysis of data of 5 patients with right sided endocarditis in a tertiary care center from 2018 to 2020 was done. Results: All of our patients were young aged females none of them had cardiac devices or history of drug use. Persistent fever was the most common clinical presentation. Interestingly, 4 patients presented clinical heart failure. 3 patients had isolated tricuspid valve IE, one patient had isolated pulmonary valve IE, and one patient have both tricuspid and pulmonary valve IE. Blood cultures were negative in two cases, whilst two others were positive to Streptococcus (alpha) and one positive to Staphylococcus. 4 patients underwent surgical treatment after well conducted antibiotic therapy the indications were the presence of right heart failure secondary to severe tricuspid regurgitation and the size of the vegetations. Unfortunately, one patient died of massive pulmonary embolism despite well conducted antibiotherapy. Conclusion: RSIE is rare and occurs in a wide range of underlying conditions like implantable electronic devices, indwelling catheters, CHD and immune compromised state. Surprisingly, it can occur in young individuals without known risk factors. In our context, rheumatic heart disease remains the most incriminated etiology which lead us to question three essential points: 1. The interest of antibiotic prophylaxis in young patients with VSDs 2. The use of empiric antibiotics with action against streptococcus 3. Early surgical treatment in rheumatic heart disease.

Underuse of Injectable Penicillin in Secondary Prophylaxis of Rheumatic Heart Disease in Nepal

2020 ◽  
Vol 01 (01) ◽  
pp. 009-012
Author(s):  
Laudari S
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
Cross Sectional Study ◽  
Secondary Prophylaxis ◽  
Medical Sciences ◽  
Cross Sectional ◽  
Governmental Organizations ◽  
Non Governmental Organizations ◽  
Rheumatic Heart

Background and Aims: Secondary prophylaxis has remained the mainstay of rheumatic fever and rheumatic heart disease management. Despite the proven ef􀏐icacy and superiority of injectable penicillin in rheumatic heart disease patients, it has been underused in Nepal. Materials and Methods: This is a hospital based cross-sectional study during June 2014 to October 2018 over a period of 52 months at College of Medical Sciences-Bharatpur including 350 patients with clinical and/or echocardiographic evidence of de􀏐inite rheumatic heart disease. Data was collected from both cardiology outpatients and inpatients (admitted in cardioward/coronary care unit). Relevant data and information were entered into the pre-structured proforma and then analyzed by SPSS-16 software. Results: The age of the patients ranged from 6 to 80 years with mean age 36.76±4.6years with female preponderance (F:M=1.26:1). The predominantly involved isolated valve was mitral in 152 patients (44.43%) followed by aortic valve in 70 patients (20.00%) and rest 90 (25.71%) had dual valvular involvement. The common complications encountered were heart failure in 200(57.14%) and arrhythmias in 155(44.29%) patients. Two hundred ten (60.00%) of the patients received penicillin (oral and injectable) and erythromycin. Majority 180/210=85.71%) were prescribed on oral penicillin whereas only 46/210=21.90% received injectable penicillin; the ratio being 3.35:1. Conclusion: RHD is a leading cause of heart failure and death among young population. There is underuse of penicillin with very minimal focus on use of injectable penicillins currently. Hence, Nepal government and other non-governmental organizations should consider implementation of use of penicillin broadly and moreover focus on use and adherence of injectable penicillin. Keywords: Rheumatic Heart Disease, Penicillin, Underuse, Secondary Prophylaxis.

scholarly journals Evolving trends in infective endocarditis in a developing country: a consequence of medical progress?

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Mohamed Sunil ◽  
Huynh Quoc Hieu ◽  
Ramesh Singh Arjan Singh ◽  
Sasheela Ponnampalavanar ◽  
Kelvin S. W. Siew ◽  
...  
Keyword(s):  
Health Care ◽  
Heart Disease ◽  
Infective Endocarditis ◽  
Rheumatic Heart Disease ◽  
Major Complication ◽  
Tertiary Hospital ◽  
Hospital Death ◽  
Medical Progress ◽  
Streptococcus Group ◽  
Rheumatic Heart

Abstract Background Staphylococcus has replaced streptococcus as the most common cause of infective endocarditis (IE) in developed health care systems. The trend in developing countries is less clear. Aim To examine the epidemiological trends of infective endocarditis in a developing nation. Methods Single-centre, retrospective study of patients admitted with IE to a tertiary hospital in Malaysia over a 12-year period. Results The analysis included 182 patients (n = 153 Duke’s definite IE, n = 29 possible IE). The mean age was 51 years. Rheumatic heart disease was present in 42%, while 7.6% were immunocompromised. IE affected native valves in 171 (94%) cases. Health-care associated IE (HCAIE) was recorded in 68 (37.4%). IE admission rates increased from 25/100,000 admissions (2012) to 59/100,000 admissions (2017). At least one major complication on admission was detected in 59 (32.4%) patients. Left-sided IE was more common than right-sided IE [n = 159 (87.4%) vs. n = 18 (9.9%)]. Pathogens identified by blood culture were staphylococcus group [n = 58 (40.8%)], streptococcus group [n = 51 (35.9%)] and Enterococcus species [n = 13 (9.2%)]. staphylococcus infection was highest in the HCAIE group. In-hospital death occurred in 65 (35.7%) patients. In-hospital surgery was performed for 36 (19.8%) patients. At least one complication was documented in 163 (85.7%). Conclusion Staphylococcus is the new etiologic champion, reflecting the transition of the healthcare system. Streptococcus is still an important culprit organism. The incidence rate of IE appears to be increasing. The rate of patients with underlying rheumatic heart disease is still high.

scholarly journals Contemporary Diagnosis and Management of Rheumatic Heart Disease: Implications for Closing the Gap: A Scientific Statement From the American Heart Association

Circulation ◽  
2020 ◽  
Vol 142 (20) ◽  
Author(s):  
Raman Krishna Kumar ◽  
Manuel J. Antunes ◽  
Andrea Beaton ◽  
Mariana Mirabel ◽  
Vuyisile T. Nkomo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
Treatment Options ◽  
Heart Association ◽  
Population Based ◽  
Diagnosis And Treatment ◽  
Optimal Care ◽  
Percutaneous Balloon ◽  
Rheumatic Heart

The global burden of rheumatic heart disease continues to be significant although it is largely limited to poor and marginalized populations. In most endemic regions, affected patients present with heart failure. This statement will seek to examine the current state-of-the-art recommendations and to identify gaps in diagnosis and treatment globally that can inform strategies for reducing disease burden. Echocardiography screening based on World Heart Federation echocardiographic criteria holds promise to identify patients earlier, when prophylaxis is more likely to be effective; however, several important questions need to be answered before this can translate into public policy. Population-based registries effectively enable optimal care and secondary penicillin prophylaxis within available resources. Benzathine penicillin injections remain the cornerstone of secondary prevention. Challenges with penicillin procurement and concern with adverse reactions in patients with advanced disease remain important issues. Heart failure management, prevention, early diagnosis and treatment of endocarditis, oral anticoagulation for atrial fibrillation, and prosthetic valves are vital therapeutic adjuncts. Management of health of women with unoperated and operated rheumatic heart disease before, during, and after pregnancy is a significant challenge that requires a multidisciplinary team effort. Patients with isolated mitral stenosis often benefit from percutaneous balloon mitral valvuloplasty. Timely heart valve surgery can mitigate the progression to heart failure, disability, and death. Valve repair is preferable over replacement for rheumatic mitral regurgitation but is not available to the vast majority of patients in endemic regions. This body of work forms a foundation on which a companion document on advocacy for rheumatic heart disease has been developed. Ultimately, the combination of expanded treatment options, research, and advocacy built on existing knowledge and science provides the best opportunity to address the burden of rheumatic heart disease.

Surgical treatment of rheumatic heart disease

1954 ◽  
Vol 17 (6) ◽  
pp. 811-825 ◽  
Author(s):  
Clarence Crafoord ◽  
Lars Werkö
Keyword(s):  
Heart Disease ◽  
Surgical Treatment ◽  
Rheumatic Heart Disease ◽  
Rheumatic Heart
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