Infective endocarditis in developing countries: An update

Abstract

IntroductionDespite advances in diagnostic and treatment, morbidity and mortality due to infective endocarditis (IE) has not decreased. There is a discrepancy in epidemiology of IE between developed and developing countries. Over the last years, increased early detection and consequently prevalence of rheumatic heart disease (RHD) and congenital heart disease (CHD) which are considered predisposing conditions for IE, is noted. Here, we present a review of literature on IE in developing countries.MethodsWe conducted a systematic literature search of IE studies in developing countries through PubMed and Embase. We have divided the studies into two groups: studies published before 2015 (group 1) and studies ≥ 2015 (group 2). The outcome was defined as a difference in epidemiology, microbiology, treatment, and mortality over time. The Scale for Assessment of Narrative Review Articles guidelines was applied.FindingsIn total, 16 studies were included. The total number of IE cases was 1,098 and 1,505 in groups 1 and 2, respectively. We compared 4/7 cohorts from group 1 (n = 789) with 5/9 cohorts from group 2 (n = 636). Six studies were not included in the comparison because they were interacting between the two cohorts. Males predominated in all studies. Rheumatic heart disease was higher in group 1 than in group 2 (42.3% vs. 30.3%, p < 0.001) while for CHD there was no change (17.6% vs. 16.7%, p = 0.672). Streptococci infections was lower in group 1 than group 2 (26.2% vs. 37.7%, p < 0.001). The proportion of Staphylococcus aureus was 15.3% in group 1 and 23.6% in group 2, p < 0.001. Negative blood culture (NBC) was higher in group 1 than in group 2 (42.2% vs. 34.1%, p = 0.002). Patients in group 1 received more surgery than in group 2 (38.8% vs. 28.8%, p < 0.001). Mortality was similar in the two groups (20.9% vs. 22.3%, p = 0.518).ConclusionThis review shows a scarcity of studies on IE in developing countries. Rheumatic heart disease and congenital heart disease are common predisposing conditions. Other risk factors are prosthetic valves, degenerative valve disease (DVD), intravenous drug use, and human immunodeficiency virus infection. While the proportion of IE cases caused by Streptococcus and Staphylococcus has increased, the number of NBC and patients getting surgery has decreased. Mortality has not changed over time. Timely diagnosis and management of patients with RHD and CHD and comprehensive management of IE are warranted.

Risk factors of ventilation dependency following cardiac surgery for infective endocarditis: focus on preoperative aortic insufficiency

“…Due to various morphological and functional changes that occur during blood storage, such as reduced deformability, in ammation, consumption of 2,3-diphosphoglycerol, release of free hemoglobin, and decreased bioavailability of nitric oxide, red blood cell infusion cannot restore su cient microcirculation oxygenation. [27] We also identi ed a signi cant positive correlation between preoperative aortic insu ciency and ventilation dependency following cardiac surgery , and the cut-off value of preoperative aortic insu ciency of 5.25 cm 2 with 100% sensitive and 64.6% speci c for the diagnosis of ventilation dependency. Endocarditis is the most common cause of acute regurgitation in aortic valve.…”

Publication Trends on Infective Endocarditis: Comprehensive Bibliometric Analysis and Visualization Between 1892 and 2022

“… 26 - 29 Recently reported that the annual number of IE cases worldwide has exceeded 1 million and the number of deaths has exceeded 66 thousand. 30 Scientific databases such as PubMed, Scopus, and WoS show a dramatic increase in the number of articles published in recent years. The increasing importance of IE, which threatens public health, has made bibliometric studies on this subject and the determination of the relevant trends necessary.…”

“…The priority should always be the diagnosis, as IE has the risk of spreading to every tissue when the patient has IE suspicion. 34 The diagnosis can be difficult in most cases and may need a combined clinical examination, microbiologic evaluation, and echocardiographic evaluation. New microbiologic and imaging techniques are required, especially in cases with negative blood cultures.…”

Endocarditis by Streptococcus pasteurianus

“…Infective endocarditis is associated with multiple complications, namely neurologic, cardiac, and septic emboli; immune reactions; and metastatic infection. Additionally, infective endocarditis has high mortality and morbidity, and despite improving diagnostic and treatment tools, the incidence is rising worldwide [1][2][3][4][5].…”