The Tygerberg Endocarditis Cohort (TEC) Study
Date
2021-12
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Stellenbosch : Stellenbosch University, 2021
Abstract
ENGLISH ABSTRACT: Background:
The diagnosis of infective endocarditis (IE) is based on the modified Duke/ESC 2015 clinical criteria. The
sensitivity of the criteria is unknown in South Africa, but high rates of blood culture negative
endocarditis (BCNIE), coupled with a change in the clinical features of IE, may limit the sensitivity.
Methods:
The Tygerberg Endocarditis Cohort (TEC) study prospectively enrolled patients with IE between
November 2019 and June 2021. A standardised protocol for organism detection, with management of
patients by an Endocarditis Team, was employed. Patients with definite IE by pathological criteria were
analysed to determine the sensitivity of the current clinical criteria.
Results:
Eighty (80) consecutive patients with IE were included of which 45 (56.3%) had definite IE by
pathological criteria. In patients with definite IE by pathological criteria, 26/45 (57.8%) of patients were
classified as definite IE by clinical criteria. BCNIE was present in 25/45 (55.6%) of patients and less than
three minor clinical criteria were present in 32/45 (75.6%) of patients. The elevation of Bartonella
serology to a major microbiological criterion of the modified Duke/ESC 2015 clinical criteria would
increase the sensitivity (56.3% vs. 77.8%; p=0.07).
Conclusion:
The sensitivity of the modified Duke/ESC 2015 clinical criteria is lower than expected in patients with IE
in South Africa, primarily due to the high rates of Bartonella-associated BCNIE. The elevation of
Bartonella serology to a major microbiological criterion, similar to the status of Coxiella burnetii in the
current criteria, would increase the sensitivity. The majority of patients with definite IE by pathological
criteria had less than three minor criteria present.
AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar.
AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar.
Description
Thesis (PhD)--Stellenbosch University, 2021
Keywords
Infective endocarditis, Rheumatic heart disease, Heart valves -- Surgery, Culturing organisms, Cardiology, Bartonella species, Blood culture, Heart disease -- Diagnosis, UCTD