CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 5, June 2013
AFRICA
171
Epidemiological and clinical features, ultrasound
findings and prognosis of right-sided infective
endocarditis in a teaching hospital in Ouagadougou
NOBILA VALENTIN YAMEOGO, KONGNIMISSON APOLINE SONDO, AIME ARSENE YAMEOGO,
LARISSA JUSTINE KAGAMBEGA, D GERMAIN MANDI, K JONAS KOLOGO, GEORGES RC MILLOGO,
B JEAN YVES TOGUYENI, ANDRE K SAMADOULOUGOU, N JEAN-PAUL KABORE, PATRICE ZABSONRE
Abstract
Introduction:
Right-sided infective endocarditis is rare. It
accounts about 5 to 10% of all infective endocarditis cases
and is prevalent in patients with congenital heart disease,
intravascular devices and drug addiction. Our study aimed to
describe the epidemiological, clinical and echocardiographic
characteristics of right-sided endocarditis and evaluate the
prognosis after treatment.
Methods:
From January 2010 to December 2011 we recruit-
ed all patients admitted to Yalgado Ouedraogo Teaching
Hospital for infective endocarditis, and selected those who
had a right-sided location. The Duke criteria were used for
diagnosis. We analysed entry points and underlying heart
disease. The causative organisms were tracked using blood
sample cultures. Ultrasound characteristics were described,
and treatment and prognosis were evaluated. Patients’ follow
up was conducted from recruitment to 30 June 2012.
Results:
In the two-year period, 14 cases of right-sided infec-
tive endocarditis were recorded, including seven cases in chil-
dren. They accounted for 29.1% of all infective endocarditis
cases. The mean age was 25.5
±
12.5 years (range 9–80 years).
The venous route was implicated in 12 cases (85.7%). Blood
cultures were positive in 11 patients. The bacteria isolated
were
Streptococcus pneumonia
in six cases,
Staphylococcus
aureus
in three and
Hemophilus influenza
in two cases. HIV
status was positive in three patients. Underlying heart diseas-
es were dominated by congenital heart disease in six cases
and peripartal cardiomyopathy in four others. Vegetations
were located in the right heart in only 11 cases.With antibiot-
ic treatment, a lowering of temperature was shown within an
average of 10 days of follow up. Two fatalities were reported.
Conclusion:
This study showed that right-sided endocarditis
is common in our clinical practice. This infection was preva-
lent in patients with congenital heart disease or peripartal
cardiomyopathy in our context, and the venous route seemed
to be the main entry point.
Keywords:
endocarditis, right heart, venous access, Burkina
Faso
Submitted 25/8/12, accepted 17/4/13
Cardiovasc J Afr
2013;
24
: 171–173
DOI: 10.5830/CVJA-2013-025
Infective endocarditis is a septicaemic state caused by
transplantation of pathogens onto a previously healthy or injured
endocardium or prosthetic valve. This definition encompasses
infections developed in congenital heart disease and pacemaker
probes.
1
The valve most commonly affected is the mitral valve in
41%, followed by the aortic valve in 38%.
2
Right-sided endocarditis is rare and represents only 5 to 10%
of infective endocarditis, according to a large case series.
3-7
It is
found in patients with congenital heart disease or intravascular
devices, and in drug addiction.
8,9
The objectives of this study were to describe the
epidemiological, clinical and echocardiographic characteristics
of right-sided endocarditis, and assess its prognosis after
treatment at the University Hospital of Ouagadougou (Burkina
Faso).
Methods
We included consecutively, from 1 January 2010 to 31 December
2011, all patients admitted to the Yalgado Ouedraogo Teaching
Hospital for diagnosis of infective or probable infective
endocarditis, according to the Duke criteria.
10
Patients were
recruited and admitted to the in-patient unit.
They were questioned to clarify the socio-demographic
confounders (age, gender and occupation), disease history (heart
disease, surgery, pacemaker, intravenous drug addiction, long-
term catheter for dialysis or chemotherapy) and general signs.
Physical examination collected information on the presence
of signs of heart failure, modification of a pre-existing heart
murmur, skin signs, Roth spots in the eye fundus examination,
neurological signs, and entry points (dental, oto-rhino-
laryngology, urogenital, venous access).
Para-clinical investigations focused on blood count,
blood cultures, Addis count, retroviral serology, ECG, chest
radiography and transthoracic echocardiography. We evaluated
right ventricular systolic function by tricuspid annular plane
systolic excursion (TAPSE), structural damage, and measured
systolic pulmonary artery pressure using tricuspid regurgitation.
Treatment with antibiotics was administered according to
the antibiogram for at least four to six weeks consecutively.
We observed the evolution and possible complications during
hospitalisation. On discharge from hospital, patients were
Yalgado Ouedraogo Teaching Hospital, Ouagadougou,
Burkina Faso
NOBILA VALENTIN YAMEOGO, MD,
KONGNIMISSON APOLINE SONDO, MD
AIME ARSENE YAMEOGO, MD
LARISSA JUSTINE KAGAMBEGA, MD
D GERMAIN MANDI, MD
K JONAS KOLOGO, MD
GEORGES RC MILLOGO, MD
B JEAN YVES TOGUYENI, MD
ANDRE K SAMADOULOUGOU, MD
N JEAN-PAUL KABORE, MD
PATRICE ZABSONRE, MD
