The Changing Etiology Of Infective Endocarditis

Abstract

ABSTRACT:
One hundred four patients with Chronic Rheumatic Heart Disease were investigated to find out the prevalence of bacterial endocarditis in this group and to document the causative organ jam s and their sensitivity pattern.

INTRODUCTION:
Since the introduction of antibiotics in the mid forties, endocarditis has been going through an evolution. The changing etiology of endocarditis has been the subject of several reports.1’2 , ‘ According to these reports, in the economically advanced countries the age has shifted from the 2nd and 4th decade to the 5th and 6th decade with a mean at about 55 years. The etiology of the disease has changed with Strep.

MATERIAL AND METHODS:

All patients with chronic valvular rheumatic  heart disease admitted consecutively to the medical C Ward of Khyber  Hospital Peshawar were included in the study.  After complete clinical assessment, samples of blood were taken from each patient on three consecutive days for blood culture.

RESULTS:
Of the 104 patients studied 60 were males and 44 females. A positive blood culture was obtained from 23 cases. None yielded a positive result in all three blood culture samples, and only one culture each was positive in all. In 10 (43.4%) a positive culture was obtained from the first culture bottle, in 5 (21.7%) the 2nd blood sample yielded a positive culture and in 8 (34.8%) the 3rd sample was the source of a positive culture.

DISCUSSION:
The results of the study show that the age distribution of our cases is the same as that of the
preantibiotic-era in the developed countries.^{1 5}
Thirty-nine per cent of our endocarditis cases were in the 2nd and 3rd decade and 56.5% in the 3rd and 4th decade. The sex ratio in our cases is similar to that reported by Lerner and Wienstein (1966) and Garvey and Neu (1973). Although in our hospital admitted cases the number of females is generally lower than that of males, however, we have taken into account the sex ratio in all cases of rheumatic heart disease and have found that in the endocarditis cases the ratio is higher.

ACKNOW LEDGEMENT:
The authors are grateful to Dr. Tasleem Akhtar, Research Director, PMRC Research Centre, Khyber Medical College, for help in the preparation of this report and to Miss Mubarik Begum for typing the manuscript. The study was approved and financed by the Pakistan Medical Research Council.