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Infective endocarditis in patients with congenitally malformed hearts: characterization of the syndrome in a developing country

Published online by Cambridge University Press:  24 October 2007

Bilal K. Siddiqui ,
Muhammed Tariq ,
Atif Jadoon ,
Ghulam Murtaza ,
Asim Syed ,
M. Bilal Abid ,
Maria Qamaruddin ,
Mehnaz Atiq  and
Raymond A. Smego
Bilal K. Siddiqui*
Affiliation:
Department of Medicine, Aga Khan University, Karachi, Pakistan
Muhammed Tariq
Affiliation:
Department of Medicine, Aga Khan University, Karachi, Pakistan
Atif Jadoon
Affiliation:
Department of Medicine, Aga Khan University, Karachi, Pakistan
Ghulam Murtaza
Affiliation:
Department of Medicine, Aga Khan University, Karachi, Pakistan
Asim Syed
Affiliation:
Department of Medicine, Aga Khan University, Karachi, Pakistan
M. Bilal Abid
Affiliation:
Department of Medicine, Aga Khan University, Karachi, Pakistan
Maria Qamaruddin
Affiliation:
Department of Medicine, Aga Khan University, Karachi, Pakistan
Mehnaz Atiq
Affiliation:
Department of Medicine, Aga Khan University, Karachi, Pakistan
Raymond A. Smego
Affiliation:
Department of Medicine, Aga Khan University, Karachi, Pakistan
*
Correspondence to: Bilal K. Siddiqui MD, Long Island Jewish Medical Center, 270-05 76th Avenue, New Hyde Park, NY 11580. Tel: 1 718 470 7270; Fax: 1 718 470 0827; E-mail: bilalkarim81@yahoo.com
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Abstract

Objective

Cardiac surgery for correction or palliation of congenital cardiac disease in infancy and childhood remains a privilege that is rarely accessible to two-thirds of the world’s population. This imbalance has created a unique spectrum of illness in patients with underlying congenital cardiac disease and complicating infective endocarditis in developing countries, including Pakistan. In this study, we characterize endocarditis as seen in such patients presenting in Karachi.

Patients and settings

We reviewed retrospectively patients admitted to Aga Khan University with underlying congenitally malformed hearts and endocarditis between 1991 and 2004.

Results

We identified 48 patients with endocarditis according to the modified Duke Criterions, with just over half the cases (54%) classified as definite endocarditis. Of the patients, 23 (49%) patients were more than 16 years old. Uncorrected left-to-right-shunts, tetralogy of Fallot, and congenital mitral valvar disease were the most common underlying defects. Patients with cyanotic defects, particularly of the complex type, were underrepresented (4%). Only 11 (22.9%) of the patients had a previous palliative or corrective surgery. In one-third of the patients (16), streptococcal species were identified as the microbiologic cause of endocarditis, and 22 (45.8%) had culture-negative endocarditis. In contrast, Staphylococcus aureus and enterococci caused endocarditis in only one patient each. There were no differences in mortality or complications between cyanotic and acyanotic congenital defects. Surgery was performed in nine (18.7%) patients with endocarditis, and of these, 13 (27.1%) died.

Conclusions

In contrast to the developed world, endocarditis in the developing countries, such as Pakistan, complicates uncorrected left-to-right shunts and tetralogy of Fallot, probably because patients with complex cyanotic defects fail to survive long after birth due to the lack of available surgery. Almost half of patients had culture-negative endocarditis, likely related to several factors.

Keywords

Endocarditiscyanotic heart defectsacyanotic heart defectsuncorrected congenital heart disease
Type
Original Article
Information
Cardiology in the Young , Volume 17 , Issue 6 , December 2007 , pp. 623 - 630
Copyright
Copyright © Cambridge University Press 2007

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