Profile of Infective Endocarditis in Nigerian Children

Abstract

Background: Infective endocarditis (IE) was initially thought to be uncommon in children but is on the increase due to improved cardiac services in the developing world. Aims: Aims of this study is to describe the profile of IE in children in Jos, Nigeria and identify the peculiarities of the disease in the locality. Methods: Case records of children diagnosed with IE based on the modified Duke’s criteria over a seven year period were retrospectively reviewed in a tertiary hospital. Their clinical manifestations, blood culture isolates, presence or absence of vegetations and clinical outcomes were documented and analyzed using Epi Info 7.   Results: Case records of thirty children were reviewed. The number of children managed increased yearly with 10 (33.3%) of them seen in the last year of the study. The clinical features were mainly non-specific - fever (70.0%), congestive cardiac failure (63.3%) and anorexia (63.3%) being the major findings. Staphylococcus aureus was the commonest isolate, present in 5 (45.5%) of the 11 blood culture-positive cases. Other organisms isolated were Klebsiella species in 3 (27.3%), Pseudomonas aeruginosa in 2 (18.2%) and Acinetobacter baumami in 1 (9.1%) child. Vegetations were detected in 12 (40.0%) children, most of them located on the mitral valve. Mortality occurred in 8 (26.7%) children and was significantly higher in males – P = 0.02. Conclusion: There is a marked increase in the number of children admitted and managed for IE in the last year of the study possibly due to an increased index of clinical suspicion of IE. A high index of suspicion is required for diagnosis because many children presented with nonspecific clinical features.