Native Valve Brucella Endocarditis

Abstract

Objective: Brucellosis is frequently seen in Mediterranean and Middle East countries, including Turkey. We report the medical and surgical management of 31 cases of native endocarditis. Material and Method: Thirty-one patients were admitted to our clinic with suspected Brucella Endocarditis. The diagnosis was established by either isolation of Brucella species, or the presence of antibodies. Following preoperative antibiotic therapy patients underwent valve replacement with excessive tissue debridment. Patients were followed up with Brucella titers, blood cultures, and echocardiography. Results: On admission all patients were febrile and mostly dyspneic (NYHA Class 3 or 4). The blood tests were normal except for elevated ESR, CRP and serological tests. The aortic valve was involved in 19 patients, mitral valve in 7 patients, and both valves in 5. After serological confirmation of BE, antibiotic therapy was maintained. Twenty-five of the patients received rifampicine, doxycycline, and cotrimaxozole; 2 of them received a combination of rifampicine, streptomycin, and doxycycline; and 4 of them received rifampicine, tetracycline, and cotrimaxozole. Tissue loss in most of the affected leaflets and vegetationswere presenting all patients. Valve replacements were performed with mechanical and biologic prostheses. All the patients were afebrile at discharge but received the antibiotics for 101, 2 ± 16, 9 days. The follow-up was 37, 1 ± 9, 2 months. Discussion: In our retrospective study, combination of adequate medical and surgical therapy resulted in declined morbidity and mortality rate. The valve replacement with aggressive debridement is the most important part of the treatment, which should be supported with efficient preoperative and long term postoperative medical treatment.

Clinical features and serum profile of inflammatory biomarkers in patients with brucellosis

“…Brucella spp. endocarditis (BE) is an uncommon infection of the cardiovascular system, but it is one of the most challenging complications of brucellosis [3,4]. Brucella melitensis is highly virulent and associated with a severe clinical course, particularly endocarditis.…”

Detached mechanical prosthesis due to Brucella endocarditis

“…Combinations of doxycycline, rifampicine, streptomycin, gentamicin, and co-trimoxazole have all been used with variable success rates. [2,4,6,7] Controversy also exists regarding the most appropriate time for surgical intervention. In general surgical practice, the indications for an operation are accepted as valvular insufficiency resulting in depressed refractory heart failure, sepsis caused by myocardial abscess and severe valvular involvement, and embolization.…”

Successful management of native-valveBrucellaendocarditis with medical therapy alone

“…Recognition of these grave complications has led to the formulation of current recommendations of aggressive management with antibiotics and early surgical intervention 1. It is not unsurprising, therefore, that reports of successful management of Brucella endocarditis with medical therapy alone are restricted to a handful of isolated cases and a few case series.…”

“…Brucellosis is a zoonosis endemic to the Mediterranean, Middle-Eastern and South-East Asian regions 1. It results from infection with members of the Brucella family—a group of Gram-negative coccobacillary organisms, and is principally transmitted through contact with fluids from infected animals and animal products, most commonly unpasteurised milk or milk products 2.…”

“…The clinical spectrum of human brucellosis ranges from inapparent, asymptomatic infection to severe disease with life-threatening complications. Cardiac involvement comprises an important complication of brucellosis and is responsible for up to 80% of Brucella -related deaths,3 although Brucella endocarditis itself occurs in only 1–2% of all cases 1. The relatively large size of Brucella vegetations, the absence of potent intravenous antibiotic therapy for brucellosis and the heightened risk of mortality associated with this form of brucellosis, have all contributed to the present approach of aggressive surgical intervention and valve replacement for patients with Brucella endocarditis.…”