CARDIOVASCULAR JOURNAL OF AFRICA • Volume 33, No 4, July/August 2022 AFRICA 199 destruction, resulting in haemodynamic failure and death prior to the implementation of corrective surgery. Limitations and strengths Our study has several limitations pertaining to its retrospective design. This included lack of complete datasets and our post hoc classification using the modified Dukes criteria to identify definite cases of IE. Furthermore, prior antibiotic therapy at the base hospital probably contributed to the high culturenegativity rate and limiting the inferences relating to the causative organisms in our sample. Another factor considered was that most subjects perceived to be stable and less symptomatic would have been managed at the base hospitals, which have limited echocardiographic facilities and therefore these cases would not have been referred early for evaluation. Our study is therefore skewed towards referrals for cases of advanced disease and more seriously ill subjects requiring intervention. Despite these caveats, there are a few strengths to our study. Most subjects underwent surgery so that we were able to confirm/ refute the clinical findings. This enabled us to withdraw 10 cases that showed no evidence of IE at operation and obtain a more accurate mortality rate. Also, our follow-up rate was almost complete, with only one patient who was lost to follow up. Conclusion This study demonstrates that IE in a developing environment was associated with significant morbidity and mortality rates despite the majority of the study subjects being young with first-time infection. Although the number of HIV-infected cases was small, the clinical presentation appeared to be similar to that of the HIV-negative cases. A sobering finding was the high number of subjects in whom life-saving surgery could not be performed. 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