THE CLINICAL, bacteriologic, immunologic, and pathologic criteria necessary for establishing the diagnosis of bacterial endocarditis are difficult to fulfill. Fortunately, since the advent of antibiotics the mortality due to bacterial endocarditis has diminished markedly, so that the majority of patients now recover, whereas previously recovery was a rare event. At the autopsy table it was possible to demonstrate the characteristic valvular vegetations and to culture the causative bacteria from the vegetations. At the present time more and more reliance must be placed on the clinical, bacteriologic, and immunologic findings in an effort to establish the correct diagnosis and the etiologic bacteria, because most patients properly treated do not reach the pathologist. Correct bacteriologic diagnosis is a necessity, because the choice of antibiotic to be employed in treatment depends on the particular bacteria responsible for the infection.There are very few reported cases of bacterial endocarditis due to Brucella. Smith and Curtis 1 in 1939 reviewed nine previous cases, including four cases of undulant fever in which the heart was affected. These latter four cases were reported by Hughes in 1897 2. Smith and Curtis reported another case. Spink and Nelson 3 in 1939 were able to find only two cases in the literature substantiated by anatomical and bacteriological evidence at necropsy. Spink and Nelson 3 ; Spink, Tritud, and Kabler,4 and Wechsler and Gustafson 16 each reported a case of bacterial endocarditis due to Brucella, and Spink and associates in a series of 84 bacteriologically proved cases had 4 with subacute bacterial endocarditis.18 Jones 5 searched the literature of the 13-year period 1936-1948, inclusive, for cases of subacute bacterial endocar¬ ditis of nonstreptococcal etiology, and she lists 18 references of endocarditis due to Brucella. In 15 of the references, case histories were detailed, but study of these references reveals that few were proved cases.The natural course of brucellosis makes differentiation from subacute bacterial endocarditis difficult; particularly is this true in patients with congenital or rheu¬ matic heart disease. Both brucellosis and subacute bacterial endocarditis may be characterized by gradual onset of malaise, fever, anorexia, chills, arthralgia, arthritis, and splenomegaly. These findings in a patient with cardiac murmurs consistent with
