Brucella Abortus Endocarditis

Fd, Hart; Morgan, Alexander E.; Lacey, B. W.

doi:10.1136/bmj.1.4714.1048

Cited by 38 publications

(12 citation statements)

References 4 publications

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“…Electrocardiogram changes mainly include involvement of the cardiac conduction system (ie, right or left bundle branch blocks or atrioventricular blocks) (25,29,31). In the present case, a complete right bundle branch block was found.…”

Section: Discussionmentioning

confidence: 65%

Brucella endocarditis in prosthetic valves

Dahouk

Schneider

Jansen

et al. 2006

Canadian Journal of Cardiology

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Brucellosis is a common zoonosis in Mediterranean countries, transmitted to humans by direct contact with infected animals or by the consumption of contaminated food (eg, unpasteurized milk or dairy products, and raw meat) (1). Four of the six named species of the genus Brucella are human pathogens: Brucella melitensis, Brucella abortus, Brucella suis and Brucella canis. Human brucellosis is a severe systemic disease that may affect any organ and is characterized by focal complications, chronic courses, therapeutic failures and relapses. The case fatality rate is low (less than 1%). However, 80% of the fatal cases are caused by endocarditis (2). In endemic areas, Brucella endocarditis has been reported in 8.5% to 14.6% of all patients treated for endocarditis (3)(4)(5). A case of Brucella endocarditis on two valvular prostheses successfully treated in Charité -Campus Benjamin Franklin (Berlin, Germany) by a combined medical and surgical approach is described. Because Brucella endocarditis is a rare complication, general treatment recommendations do not exist for this potentially fatal complication. Therapeutic strategies in Brucella endocarditis are discussed. CASE PRESENTATIONA 55-year-old Turkish woman was hospitalized primarily because of remittent fever up to 39.5°C, accompanied by night sweats and abnormal fatigue; she also suffered from left thoracic pain. Her medical history revealed an episode of rheumatic fever during childhood, followed by rheumatic disease of the heart valves. Because of combined mitral regurgitation and stenosis, a St Jude Medical prosthesis (St Jude Medical, USA) was implanted when the patient was 37 years of age. The aortic valve was also replaced due to insufficiency by the same type of prosthesis two years before admission to the hospital. Transesophageal echocardiography (TEE) did not show any vegetation on the two valves. However, Enterobacteriaceae were found in urine cultures. Urinary tract infection was suspected and the patient was treated with co-trimoxazole. Body temperature decreased to normal values, and her health improved markedly. Four weeks later, blood cultures taken before antibiotic treatment yielded B melitensis bv 2. The isolates were identified by the German Reference Laboratory for brucellosis located at the Federal Institute for Risk Assessment (Berlin, Germany) following the standard laboratory procedures described by Alton et al (6). Rifampin and doxycycline were recommended for six weeks, but were only taken for two weeks because of noncompliance. A re-evaluation of the medical history did not reveal the probable source of infection, but the consumption of unpasteurized goat's milk and cheese during a family stay in Turkey seemed to be highly probable. Human brucellosis is a multiple organ disease that presents with fever and is most often transmitted via contaminated, unpasteurized goat milk and cheese. In chronic cases, focal complications (eg, spondylitis, neurobrucellosis and endocarditis) are frequently seen. Although the disease may be severely debi...

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Section: Discussionmentioning

confidence: 65%

Brucella endocarditis in prosthetic valves

Dahouk

Schneider

Jansen

et al. 2006

Canadian Journal of Cardiology

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“…The histological changes were sometimes similar to Aschoff bodies (Call, Baggenstoss and Merritt, 1944). The patients with myocardial involvement had a relatively high prevalence of rheumatic heart disease and calcific aortic stenosis (Peery and Belter, 1960;Hart et al, 1951;Call et al, 1944;Cleveland, Suchar and Daglie, 1978). It is of importance that electrocardiographic changes were, in general, very rare and mild, even in cases with post-mortem evidence of cardiac involvement.…”

Section: Discussionmentioning

confidence: 91%

“…O'Meara collected only 15 case reports of brucella endocarditis between the years 1936-1948(O'Meara et al, 1974 and Hart reported 12 cases until 1951 (Hart, Morgan and Lacey, 1951). Buchanan reviewed 160 cases of brucellosis in the U.S. A.…”

Section: Discussionmentioning

confidence: 99%

“…Dalrymple-Champneys (1950), who reviewed 983 cases of brucellosis in England, could not find a report of endocarditis. Only a few cases of brucellosis with myocardial or pericardial involvement have been reported (Peery and Belter, 1960;Hart et al, 1951;Dalrymple-Champneys, 1950;Hunt and Bothwell, 1967 disease and included atrioventricular or right bundle branch block; they were also observed in patients whose course was complicated by rupture of the sinus of Valsalva (Hart et al, 1951) and were, in most cases, associated with endocarditis (Peery and Belter, 1960). Peery and Belter (1960) described three patients with myocarditis without endocarditis, but the course of the disease was nevertheless fulminant and fatal.…”

Section: Discussionmentioning

confidence: 99%

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Transient electrocardiographic changes during two episodes of relapsing brucellosis

Gur¹,

Gefel²,

Tur–Kaspa³

1984

Postgraduate Medical Journal

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Summary Cardiac involvement in the course of acute brucellosis is rare and, when present, is usually manifested by endocarditis. Myocarditis is very infrequent and in the few reported cases, the course of the disease was fulminant. A patient with recurrent brucellosis who presented transient electrocardiographic T wave changes during two episodes of acute illness is reported. It is suggested that the patient had minor asymptomatic myocarditis in the course of recurrent brucellosis.

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“…Undulant fever is not a rare disease in this country; yet endocarditis due to Brucella organisms has only twice been recorded here (Rennie and Young, 1936;Hart et al, 1951), and only in the latter case was it confirmed bacteriologically at necropsy. Dalrymple-Champneys (1950), in his series of 983 cases of undulant fever, does not record a single example.…”

mentioning

confidence: 77%