Infective endocarditis. An African experience.

A two-year review of I02 consecutive cases of infective endocarditis is presented from Uganda.Fifty-seven patients were diagnosed at clinical presentation and 45 were diagnosed only at nec- ropsy.The majority of patients clinically presenting with infective endocarditis had underlying rheumatic heart disease, with staphylococci and streptococci the commonest infecting organisms.On adequate antibiotic therapy the mortality was I9 per cent.The majority of those diagnosed at necropsy presented an acute course with rapid termination in cardiac failure, frequently due to acute valvular destruction in the absence of pre-existing valvular disease.These experiences in a developing country are different from the spectrum of infective endocarditis as seen at present in western countries.Studies of infective endocarditis in African populations are few.Necropsy surveys from Uganda (Davies, I948) mentioned the fre- quent occurrence of acute bacterial endocar- ditis of the aortic valve in the absence of antecedent heart disease.Subacute bacterial endocarditis complicating rheumatic heart disease was stated to be uncommon.In a clinical report (D'Arbela, Kanyerezi, and Tulloch, I966), bacterial endocarditis ac- counted for 2-2 per cent of all cardiovascular admissions.A short clinical report of bacterial endocarditis in Uganda was made by Brenton et al. (i968).The present study was undertaken to define the pattern of infective endocarditis at Mu- lago Hospital.The aims were to assess clinical presentation, sources of infection, causative organisms, and prognosis, and to compare the findings with current experience in western countries. Subjects and methods Each patient admitted to Mulago Hospital be- tween January I968 and December I969 with the clinical diagnosis of infective endocarditis was