Features of infective endocarditis in injection drug users

Abstract

Aim. To reveal the peculiarities of clinical manifestations of infectious endocarditis in injection drug addicts.Material and methods. Clinical, laboratory, echocardiographic manifestations of infectious endocarditis in 40 injecting drug addicts and in 21 patients of control group were analysed. Among injection drug users there were 22 men aged 40,0±2,9 years and 18 women aged 29,5±2,3 years. The history of the disease, clinical manifestations, laboratory markers of inflammation, the results of bacteriological blood tests, and the dynamics of the state during therapy were analyzed. Echocardiography at admission to hospital and at the end of treatment was carried out on a Vivid E-9 apparatus using transthoracic and transesophageal probes. The electrocardiogram was recorded in 12 standard leads. All patients underwent an x-ray examination of thoracic organs or multispiral pulmonary tomography, ultrasound of the liver and spleen. Statistical analysis of the research results was conducted using Statistica 7.0, Microsoft Office Excel.Results. We determined significantly younger age of patients in the group of injection drug users (p<0,05). The most frequently detected manifestation of infective endocarditis in both groups was fever. According to echocardiography data, tricuspid valve isolated localization of endocarditis was found in 90%. Radiographically, 8,2% of drug-dependent patients had signs of pneumonia (often bilateral multisegmental), regarded as a manifestation of the thromboembolic syndrome by vegetation particles. Splenomegaly (75%) was detected in the majority of drug addicts, less often — hepatomegaly (47,5%). Manifestations of chronic heart failure were detected only in 12,5% of patients who use drugs, the kidneys were less involved in the process. An association of infective endocarditis with HIV infection (72,5%) and hepatitis C was detected in 97,5% of patients.Conclusion. Knowing of the infective endocarditis features in drug addicts makes it possible to improve the approaches to the diagnostics in earlier periods of its progression and thus makes the treatment of these patients more promising.

Keywords

• infective endocarditis
• injection drug users
• clinical presentation
• diagnosis
• treatment