title: Infective endocarditis in the Lao PDR: clinical characteristics and outcomes in a developing country.
abstract: BACKGROUND
  Data on infective endocarditis (IE) in Southeast Asia are scarce.
  
  
  OBJECTIVE
  To describe the clinical epidemiology of IE in Lao PDR, a lower middle-income country.
  
  
  METHODS
  A single centre retrospective study at Mahosot Hospital, Vientiane. Patients aged over 1year of age admitted 2006-2012 to Mahosot Hospital with definite or possible IE by modified Duke criteria were included.
  
  
  RESULTS
  Thirty-six patients fulfilled the inclusion criteria; 33 (91.7%) had left-sided IE. Eleven (30.6%) had definite IE and 25 (69.4%) possible left-sided IE. Median age was 25years old [IQR 18-42]. Fifteen patients (41.7%) were males. Underlying heart diseases included: rheumatic valve disease in 12 (33.3%), congenital heart disease in 7 (19.4%), degenerative valve disease in 3 (8.3%), and of unknown origin in 14 (38.9%) patients. Native valve IE was present in 30 patients (83.3%), and prosthetic valve IE in 6 patients (16.7%). The most frequent pathogens were Streptococcus spp. in 7 (19.4%). Blood cultures were negative in 22 patients (61.1%). Complications included: heart failure in 11 (30.6%), severe valve regurgitation in 7 (19.4%); neurological event in 7 (19.4%); septic shock or severe sepsis in 5 (13.9%); and cardiogenic shock in 3 patients (8.3%). No patient underwent heart surgery. Fourteen (38.9%) had died by follow-up after a median of 2.1years [IQR 1-3.2]; and 3 (8.3%) were lost to follow-up.
  
  
  CONCLUSIONS
  Infective endocarditis, a disease especially of young adults and mainly caused by Streptococcus spp., was associated with rheumatic heart disease and had high mortality in Laos.
authors.affiliation: INSERM U970, Paris Cardiovascular Research Center PARCC, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France. Electronic address: mariana.mirabel@inserm.fr.
authors.forename: Mariana
authors.initials: M
authors.lastname: Mirabel
authors.affiliation: Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic.
authors.forename: Sayaphet
authors.initials: S
authors.lastname: Rattanavong
authors.affiliation: Cardiology Department, Mahosot Hospital, Vientiane, Lao People's Democratic Republic.
authors.forename: Khamthavy
authors.initials: K
authors.lastname: Frichitthavong
authors.affiliation: Cardiology Department, Mahosot Hospital, Vientiane, Lao People's Democratic Republic.
authors.forename: Vang
authors.initials: V
authors.lastname: Chu
authors.affiliation: Cardiology Department, Mahosot Hospital, Vientiane, Lao People's Democratic Republic.
authors.forename: Pany
authors.initials: P
authors.lastname: Kesone
authors.affiliation: Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic.
authors.forename: Phonvilay
authors.initials: P
authors.lastname: Thongsith
authors.affiliation: INSERM U970, Paris Cardiovascular Research Center PARCC, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Jouven
authors.affiliation: Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Centre National de la Recherche Scientifique-Institut de Recherche pour le Développement, Unité Mixte de Recherche 6236, Faculté de Médecine, Université de la Méditerranée, France.
authors.forename: Pierre-Edouard
authors.initials: PE
authors.lastname: Fournier
authors.affiliation: Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Churchill Hospital, University of Oxford, Oxford, United Kingdom.
authors.forename: David A B
authors.initials: DA
authors.lastname: Dance
authors.affiliation: Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Churchill Hospital, University of Oxford, Oxford, United Kingdom.
authors.forename: Paul N
authors.initials: PN
authors.lastname: Newton
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D003906:Developing Countries; D004696:Endocarditis / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D006801:Humans; D015994:Incidence; D007812:Laos / Q000453:epidemiology; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Developing countries; Heart valve disease; Infective endocarditis; Lao PDR; Laos; Rheumatic heart disease; Septicemia