Clinicomicrobiological profile of infective endocarditis in a tertiary care centre of Nepal

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Background: Infective endocarditis is a common problem and data regarding its clinical and microbiological pattern from developing countries are sparse. We studied clinical features and the microbiological pathogens in patients with Infective Endocarditis.

Methods: A hospital based, cross sectional descriptive study was carried out over a period of 1 year.

Results: A total of 54 patients with history of fever and underlying heart disease were evaluated for IE. Out of them 11 patients (20.4%) had Dukes definite IE. Fever was present in 100% cases (n=11) as it was the inclusion criteria of the study, followed by SOB 81.8% (n=9), anorexia 81.8% (n=9), malaise 63.6% (n=7), cough 54.4% (n=6), palpitation 45.5% (n=5), swelling of body 45.5% (n=5), myalgia 36.4% (n=4). Past history of RHD was present in 18.2% (n=2) and only 18.2% (n=2) of patients were in penicillin prophylaxis. No patients had undergone any dental procedure in last 2 weeks prior to the presentation. One patient (9.1%) was intravenous drug abuser and 36.7% (n=4) of patients were smoker. History of antibiotic therapy prior to the presentation was present in 36.7% (n=4) patients. None of the patients had a history of prior IE. Pallor was the most common sign 63.6% (n=7), followed by edema 54.5% (n=6), icterus 36.4% (n=4). Embolic events seen in 18.2% (n=2). Dental caries and focal neurological deficit were seen in 9.1% (n=1) each. Peripheral signs in IE were not seen in any of the cases. Petechial hemorrhage in 18.2% (n=2) patients. Anemia (Hb<10gm %) in 36.4% (n=4) cases, leucocytosis and microscopic haematuria in 72.3% (n=8) and 27.3% (n=3), respectively. Blood culture positivity was seen in 36.4% .The most common pathogens were Staphylococcus aureus in 27.3% (n=3), and Acinetobacter species in 9.1% (n=1).

Conclusion: Clinical spectrum of IE in our study was different from the west.Majority of patients being young, RHD still being the common underlying heart disease. However microbiological pattern was similar to western studies, i.e. staphylococcus aureus being the commonest isolate. So, we need a large study to know the real epidemiological, microbiological pattern of IE in our country.