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   Table of Contents     
LETTER TO EDITOR  
Year : 2016  |  Volume : 8  |  Issue : 3  |  Page : 124-125
Right-sided infective endocarditis in an Indian Intensive Care Unit


1 Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
2 Department of Medicine Kasturba Medical College, Manipal University, Manipal, Karnataka, India

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Date of Web Publication17-Aug-2016
 

How to cite this article:
Vallabhajosyula S, Varma MD, Vallabhajosyula S, Vallabhajosyula S. Right-sided infective endocarditis in an Indian Intensive Care Unit. J Global Infect Dis 2016;8:124-5

How to cite this URL:
Vallabhajosyula S, Varma MD, Vallabhajosyula S, Vallabhajosyula S. Right-sided infective endocarditis in an Indian Intensive Care Unit. J Global Infect Dis [serial online] 2016 [cited 2019 Apr 18];8:124-5. Available from: http://www.jgid.org/text.asp?2016/8/3/124/188598


Sir,

Right-sided infective endocarditis (RSIE) is seen in 5-10% of IE cases and is commonly associated with intravenous drug use (IVDU) in developed nations. [1] However, the Indian population has a lesser incidence of IVDU, but Indian data are limited to two case series from the 1990s. [2],[3] We reviewed all RSIE cases admitted to the Intensive Care Unit (ICU) of a tertiary-care academic medical center in India from January 2010 to December 2014. All patients >18 years with a diagnosis of IE by the modified Duke criteria were included in the study. Patients discharged against medical advice and pregnant females were excluded from the study. During this period, 96 patients were admitted to the ICU with IE, with 11 patients (11.5%) having RSIE. Median age was 33 (28-53) years with 4 (36.4%) males. Median Charlson age-comorbidity index was 1 (0-3) and no patient had an immunocompromised state, history of alcohol abuse, IVDU, central venous catheters, or implantable cardiac defibrillators at the time of presentation or diagnosis. Nine (81.8%) and 10 (90.1%) of the 11 patients presented with fever and a new cardiac murmur; however, vascular and immunological phenomena were seen only in 4 (36.4%) and 1 (9.1%) patients, respectively. Eight (72.7%), 2 (18.2%), and 1 (9.1%) patients had tricuspid valve (TV), pulmonary valve, and bivalvular involvement, respectively. Median vegetation size was 2.0 cm (1.3-2.1) × 0.8 cm (0.5-1.4). Staphylococcus aureus was the most common pathogen (5 patients, 45.5%), with 2 (18.2%) being methicillin-resistant S. aureus (MRSA). TV and pulmonary valve regurgitation were noted in 8 (82.7%) and 6 (54.5%) patients, respectively. Acute kidney injury, septic shock, acute respiratory distress syndrome, and decompensated heart failure were noted in 2 (18.2%), 3 (27.3%), 2 (18.2%), and 1 (9.1%) patients, respectively. Median ICU stay was 7 (3-16) days. Medical therapy was successful for 8 (72.7%) patients, with 2 (18.2%) requiring surgical resection and TV replacement.

The Asian population is unique in its inherently low incidence of IVDU, with RSIE incidence of <9%. [1],[2],[3],[4],[5] Clinically, fever and a new cardiac murmur are common presenting features with a low incidence of vascular and immunological phenomena. [5] S. aureus continues to be the leading pathogen in India and Asia, with about 40% of MRSA in our study, demonstrating an etiological shift. [2],[3] Early surgical therapy is often recommended for aggressive infection with Staphylococcus and Streptococcus species. [1],[4] The European Society of Cardiology guidelines recommend avoiding surgery except in cases of right heart failure, difficult to eradicate organisms, vegetations >20 mm, all refractory to medical therapy. [1],[4],[5] Older Indian literature [2],[3] demonstrated a higher mortality of about 30%, but our study showed a significant decrease to 9%, which is comparable with current global literature. [1],[5] In summary, we present an exclusive Indian RSIE series in over 25 years, which is also the first dedicated ICU RSIE study. During this period, there has been a significant evolution in the microbiological and antimicrobial spectra and advances in diagnostic and management techniques, leading to improved patient care. We highlight the changes in etiology and risk factors and demonstrate improvement in outcomes and mortality in comparison to prior studies. [2],[3]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest

 
   References Top

1.
Akinosoglou K, Apostolakis E, Marangos M, Pasvol G. Native valve right sided infective endocarditis. Eur J Intern Med 2013;24:510-9.  Back to cited text no. 1
    
2.
Grover A, Anand IS, Varma J, Choudhury R, Khattri HN, Sapru RP, et al. Profile of right-sided endocarditis: An Indian experience. Int J Cardiol 1991;33:83-8.  Back to cited text no. 2
    
3.
Bahl VK, Vasan RS, Jain P, Shrivastava S. Spectrum of right-sided infective endocarditis: An Indian experience. Int J Cardiol 1992;35: 187-93.  Back to cited text no. 3
    
4.
Akinosoglou K, Apostolakis E, Koutsogiannis N, Leivaditis V, Gogos CA. Right-sided infective endocarditis: Surgical management. Eur J Cardiothorac Surg 2012;42:470-9.  Back to cited text no. 4
    
5.
Yuan SM. Right-sided infective endocarditis: Recent epidemiologic changes. Int J Clin Exp Med 2014;7:199-218.  Back to cited text no. 5
    

Top
Correspondence Address:
Dr. Saraschandra Vallabhajosyula
Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-777X.188598

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2008 Journal of Global Infectious Diseases | Published by Wolters Kluwer - Medknow
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