title: Infective endocarditis in the Western Cape Province of South Africa: a three-year prospective study.
abstract: BACKGROUND
  The last 50 years have seen major changes in the epidemiology of infective endocarditis (IE).
  
  
  OBJECTIVE
  To evaluate local patient characteristics, risk factors, clinical sequelae, microbiology, morbidity and mortality in patients with definite IE.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Over a three-year period, patients referred with probable IE were prospectively enrolled. All received a standardized diagnostic evaluation. Epidemiological data were documented; underlying risk factors for IE were sought. Initial evaluation and follow-up (to 6 months) included the documentation of vascular or immunological phenomena, morbidity and mortality.
  
  
  RESULTS
  Of 92 patients referred with probable IE, 47 had definite IE. These patients had a mean age of 37.7 years with a male predominance (1.6:1). Rheumatic heart disease was present in 36 (76.6%). Eight had prosthetic valves. Three had congenital heart disease, mitral valve prolapse or multiple central intravascular catheters, respectively. All denied the use of intravenous recreational drugs and only one tested seropositive for HIV. Renal involvement (59.6%) and clubbing (29.8%) were commonly observed. The 6-month mortality rate was 35.6%, while 44.7% needed valvular replacement. An aetiological diagnosis was made in 21, with viridans streptococci the most common isolate.
  
  
  CONCLUSIONS
  Infective endocarditis in the Western Cape of South Africa is a disease of younger adults, with a male predominance. Rheumatic heart disease is the major predisposing factor. Degenerative heart disease and intravenous drug abuse are not important risk factors. Our data do not support the notion that HIV infection is an independent risk factor for IE. Local mortality rates are much higher than recent international figures, as is the proportion of 'culture-negative' IE.
authors.affiliation: Department of Internal Medicine, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa.
authors.forename: C F N
authors.initials: CF
authors.lastname: Koegelenberg
authors.forename: A F
authors.initials: AF
authors.lastname: Doubell
authors.forename: H
authors.initials: H
authors.lastname: Orth
authors.forename: H
authors.initials: H
authors.lastname: Reuter
mesh_terms: D000328:Adult; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012214:Rheumatic Heart Disease / Q000453:epidemiology; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology