Khaled Al-Aghbari, Al-Noami Alezzy Yahya, Al-Ansi Mohamed, Faiza Ahmed Askar
Department of Internal Medicine, Faculty of Medicine, Sana'a University, Yemen.
Heart Views. 2010 Mar;11(1):2-9.
Infective endocarditis is a common disease in Yemen. Although the incidence of rheumatic valvular disease and uncorrected congenital heart disease in adults is high in Yemen, there are few data regarding the pattern, characteristic features and outcome of infective endocarditis in Yemen.
The aim was to study the characteristic, clinical features and diagnostic criteria of infective endocarditis in Yemeni patients and the outcome in patients treated with medical therapy.
Seventy-two consecutive patients admitted to Kuwait teaching hospital in Sana'a with suspected infective endocarditis between June 1, 2005 and June 1, 2007 were included in this study. A questionnaire including history, clinical findings, and result of requested investigations, treatment, complications and outcome was used. The diagnosis was based on Dukes criteria, which proposed two major or five minor criteria. In our study, we included raised erythrocyte sedimentation rate (ESR) as a minor criteria. The patients were classified as definite, possible and rejected cases. All patients received empirical antibiotic therapy.
The mean age was 28.56 ± 14.5 years. Men were 30 (42.2%) while women were 42 (57.7%). 59 (81.9%) of the patients had been admitted due to fever. Past history of rheumatic heart disease was positive in 38 (53.3%) of the patients. Mitral regurgitation was the commonest form of valvular affection 54 (82.1%) of patients followed by aortic regurgitation in 45 (63%). Anemia was present in 53 (74%) while raised erythrocyte sedimentation rate was high in all patients. Vegetations were detected by transthorasic echocardiography in 51 (70.83%) of the patients while blood culture was positive in only 7 (9.6%). After adding high ESR to the criteria, definite infective endocarditis were found in 34 (47.2%); possible in 38 (52.7%) and no rejected patients. Sixty-two (87.5%) of the patients improved and were discharged in good general condition. Nine patients died, an In hospital mortality of 12.5 %.
patients with IE in Yemen were younger than those patients in western countries, RHD is the commonest predisposing factor. Duke's criteria in addition to high ESR as minor criteria improved the diagnostic possibilities and using empirical antibiotic therapy improves the outcome.
感染性心内膜炎在也门是一种常见疾病。尽管也门成人风湿性瓣膜病和未矫正先天性心脏病的发病率较高，但关于也门感染性心内膜炎的发病模式、特征和结局的数据却很少。
旨在研究也门患者感染性心内膜炎的特征、临床特征和诊断标准以及接受药物治疗患者的结局。
本研究纳入了2005年6月1日至2007年6月1日期间连续入住萨那科威特教学医院且疑似感染性心内膜炎的72例患者。使用了一份包括病史、临床检查结果、所需检查结果、治疗、并发症和结局的问卷。诊断基于杜克标准，该标准提出了两条主要标准或五条次要标准。在我们的研究中，我们将红细胞沉降率（ESR）升高作为一条次要标准纳入。患者被分为确诊、可能和排除病例。所有患者均接受经验性抗生素治疗。
平均年龄为28.56±14.5岁。男性30例（42.2%），女性42例（57.7%）。59例（81.9%）患者因发热入院。38例（53.3%）患者有风湿性心脏病病史。二尖瓣反流是最常见的瓣膜病变形式，54例（82.1%）患者出现，其次是主动脉瓣反流，45例（63%）患者出现。53例（74%）患者存在贫血，所有患者红细胞沉降率均升高。经胸超声心动图在51例（70.83%）患者中检测到赘生物，而血培养仅7例（9.6%）呈阳性。在将高ESR纳入标准后，确诊感染性心内膜炎患者34例（47.2%）；可能病例38例（52.7%），无排除病例。62例（87.5%）患者病情改善并以良好的一般状况出院。9例患者死亡，住院死亡率为12.5%。
也门感染性心内膜炎患者比西方国家的患者年轻，风湿性心脏病是最常见的易感因素。杜克标准加上高ESR作为次要标准提高了诊断可能性，使用经验性抗生素治疗改善了结局。
