CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 2, May/June 2023 84 AFRICA Positive cultures were encountered in only 41 patients (45.56%) and the most prevalent pathogen was methicillinresistant Staphylococcus aureus (MRSA), which was seen in 22 patients out of the 41 with a positive culture (53.7%) (Table 3). All patients had at least one two-dimensional (2D) TTE done (100%), while only 76 patients underwent a 2D TEE study (84.44%), when indicated. The mean of the maximal vegetation size was 17 ± 9 mm (range 5–35 mm). The mean left ventricular ejection fraction (LVEF) was 58.19 ± 8.24%. The most prevalent site of vegetations was the left heart (55 patients; 61.11%) and the most affected valve was the native mitral valve in 32 patients (35.56%) (Table 4). Only 27 patients did not receive any antimicrobial therapy before their presentation (30%), while the remaining patients received at least one antimicrobial drug for the management of their symptoms before being diagnosed. During admission, most of the patients received the guideline-recommended empirical antibiotic therapy until the pending blood culture results were obtained. The most commonly prescribed drug was gentamycin in 82 patients (91.11%), followed by vancomycin in 79 patients (87.78%) (Table 5). Persistent fever was the most encountered problem in the 38 hospitalised patients (42.22%), followed by embolic complication, which was seen in 29 patients (32.22%). The most common sites of embolism were cerebrovascular in eight patients (8.89%) and lower limbs in eight patients (8.89%). Surgery was indicated in 82 patients (91.11%), but it was performed in only 26 (28.89%). The most common indication for surgery was haemodynamic (40.2%), followed by embolic indications (35.4%). The most common cause of failure to Table 2. Detail of valve lesions Valve lesions Number (%) Aortic valve Prosthesis 16 (17.78) Mechanical 13 (14.44) Biological 3 (3.33) Native 28 (31.11) Stenosis 1 (1.11) Regurgitation 25 (27.78) Combined 2 (2.22) Mitral valve Prosthesis 16 (17.78) Mechanical 12 (13.33) Biological 4 (4.44) Native 32 (35.56) Repair 2 (2.22) Stenosis 3 (3.33) Regurgitation 23 (25.56) Combined 4 (4.44) Tricuspid valve Prosthesis 4 (4.44) Mechanical 1 (1.11) Biological 3 (3.33) Native 15 (16.67) Repair 1 (1.11) Regurgitation 14 (15.56) Pulmonary valve Native 4 (4.44) Repair 2 (2.22) Regurgitation 2 (2.22) Risk factors Number of patients Smoking 44 24 9 7 7 7 3 2 2 2 2 2 1 1 1 1 Intravenous drug injection HIV infection HBV/HCV infection Alcohol Diabetes Transient ischaemic attack/stroke Thyroid disease Autoimmune disease Steroids Immunosuppressive drugs Dyslpidaemia Chronic obstructive pulmonary diease Chronic kidney disease Intravenous catheter Hypertension Fig. 1. Most common risk factors. HBV, hepatitis B; HCV, hepatitis C. Table 3. Laboratory data Laboratory data Mean ± SD or n (%) Biochemical laboratory investigations Positive rheumatoid factor 56 (62.22) Haemoglobin (g/dl) 9.99 ± 2.09 White blood cells (giga/l) 12.81 ± 4.9 Platelets (giga/l) 235 ± 90 Creatinine (mg/dl) 0.95 ± 0.4 C-reactive protein (mg/l) 114.66 ± 65.99 Troponin (ng/ml) 1.06 ± 3.38 B-type natriuretic peptide (pg/ml) 536.8 ± 465.6 Procalcitonin (ng/ml) 1.45 ± 2.57 Microbiological laboratory investigations Negative cultures 49 (54.44) Positive cultures 41 (45.56) Streptococcus viridans 7 (7.78) MSSA 4 (4.44) MRSA 22 (24.44) Coryneform bacilli 2 (2.22) Stenotrophomonas 2 (2.22) Enterococcus 4 (4.44) MRSA: methicillin-resistant Staphylococcus aureus, MSSA: methicillin-sensitive Staphylococcus aureus. Signs and symptoms Number of patients Fever 87 50 27 25 6 4 2 2 2 0 0 0 0 Dyspnoea Cough Peripheral embolisation Cerebrovascular accident Dizziness Septic shock Janeway lesions Syncope Cardiogenic shock Osler nodules Roths spots Audible murmur Fig. 2. Most common symptoms and signs.
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