Surgical treatment of brucella endocarditis

Keleş, Cüneyt; Bozbuğa, Nilgün; Şişmanoğlu, Mesut; Güler, Mustafa; Erdoğan, Hasan; Akinci, Esat; Yakut, Cevat

doi:10.1016/s0003-4975(00)02663-1

Cited by 41 publications

(45 citation statements)

References 14 publications

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“…These indications for surgical therapy in Brucella endocarditis are in accordance with the guidelines of the American Heart Association for the management of infective endocarditis in general (35). Valve replacement can be performed in spite of active disease, because the risk for recurrent infection of the newly implanted prosthesis seems to be low (10,13,18,25,33). However, valve replacement during the active phase of infection may lead to postoperative periprosthetic leakage (16).…”

Section: Discussionmentioning

confidence: 87%

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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: 87%

“…Brucella prosthetic valve endocarditis on mechanical and bioprostheses has been described frequently (5,(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). In endemic areas, such as Saudi Arabia, Brucella has established a high incidence (approximately 10%) among the causative agents of prosthetic valve endocarditis (12,15).…”

Section: Discussionmentioning

confidence: 99%

Brucella endocarditis in prosthetic valves

Dahouk

Schneider

Jansen

et al. 2006

Canadian Journal of Cardiology

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“…Nevertheless, it is a severe complication with a high mortality rate. [1][2][3] Although both native and prosthetic valves are affected, there are only a few reports in the literature of prosthetic valve endocarditis due to the Brucella species. [2,4] Due to the slow growth rate of this bacteria and its need for a suitable culture medium, BE is often associated with a higher rate of negative blood cultures.…”

Section: Discussionmentioning

confidence: 99%

“…[1] Brucella appears to be a slowly destructive organism with a marked tendency toward tissue ulceration and the development of large vegetations. In addition, it is difficult to eradicate with medical therapy alone.…”

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confidence: 99%

Detached mechanical prosthesis due to Brucella endocarditis

Ada¹

2014

Turk Gogus Kalp Dama

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Bu yazıda, ameliyat öncesi antibiyotik tedavisini takiben agresif cerrahi debridman ile başarılı bir şekilde tedavi edilen, Brusella endokarditine bağlı mekanik kapak ayrıl-ma olgusu sunuldu.Anah tar söz cük ler: Brusella hastalığı; endokardit; cerrahi.In this article, we report a case of detached prosthetic valve due to Brucella endocarditis, which was successfully treated with aggressive surgical debridement following preoperative antibiotic treatment.Keywords: Brucellosis; endocarditis; surgery.Brucella endocarditis (BE) is a rare complication of brucellosis, but it is the primary cause of mortality related to this disease. Brucella appears to be a slowly destructive organism with a marked tendency toward tissue ulceration and the development of large vegetations. In addition, it is difficult to eradicate with medical therapy alone.[2] To achieve a cure, removal and replacement of the infected tissue or prosthetic material has been recommended along with long-term antibiotic treatment.[2]Herein, we present a patient with a detached prosthetic valve due to BE who was successfully treated with aggressive surgical debridement following preoperative antibiotic treatment. CASE REPORTA 51-year-old male with a history of aortic valve replacement was admitted to the hospital with a fever that had lasted for two weeks along with weakness and polyarthralgia.His vital signs, except for an elevated body temperature, were normal, and a 2/6 degree diastolic murmur was present on the left sternal border. Although he had moderate pretibial edema, there were no clinical signs of congestive heart failure.His erythrocyte sedimentation rate (ESR) (74 mm/h) and C-reactive protein (CRP) level (16 mg/dL) were elevated, but his leukocyte count was normal. Except for decreased serum protein and albumin levels (total protein: 4.86 g/dL and albumin: 2.12 g/dL), all of the laboratory test results were within normal ranges.Transthoracic (TTE) and transesophageal echocardiography (TEE) revealed a dense and bright mobile mass (vegetation) on the entire surface of the posterior leaflet of the prosthetic aortic valve. Additionally, we observed another vegetation stuck to the subaortic portion of the interventricular septum (Figure 1 and 2). The maximum and mean aortic gradients were 38 mmHg and 25 mmHg, respectively, and second-to third-degree aortic insufficiency was present.After positive blood cultures and Brucella agglutination tests (>1/1280), rifampicine, cotrimoxazole, and tetracycline were administered. The patient was then followed up with weekly echocardiography and blood cultures. After two weeks of this treatment and negative blood cultures, he was then scheduled for surgery.During the reoperation, a totally detached aortic prosthesis was observed with a large vegetation attached to it. The infected mechanical prosthesis (Figure 1)

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“…6) Although it is rare in nonendemic regions, Brucella endocarditis may reach up to 10.9% in endemic regions. 7,8) A high level of clinical suspicion is the first step for diagnosis, especially in endemic areas.…”

Section: Discussionmentioning

confidence: 99%

A Case of Mitral Stenosis Complicated With Seronegative Brucella Endocarditis

Yavuz¹,

Ozaydin²,

Ulusan

et al. 2004

Jpn Heart J

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SUMMARYBrucellosis is a multisystemic disease. The most common cause of death from the disease is endocarditis. The aortic valve is most commonly affected. The disease rarely involves the mitral valve.A 30 year-old woman presented with complaints of chills and fever up to 38°C at night, fatigue, palpitations, and dyspnea for the previous 3 weeks. Cardiac auscultation revealed a diastolic murmur in the mitral area. Her temperature was 38.3°C. On echocardiographic examination, the mitral valve area was 0.62 cm 2 and an isoechoic mass thought to be a vegetation was detected on the anterior mitral leaflet. A diagnosis of infective endocarditis was made and vancomycin administration was commenced.Brucella melitensis was isolated in all three blood samples, however, the patient remained seronegative with Brucella agglutination titers of up to 1/160. The antibiotic therapy was then shifted to doxycycline (200 mg/day), rifampicin (600 mg/day), and ciprofloxacin (1000 mg/day). After 30 days of treatment, surgery was performed for the severely stenotic mitral valve and to remove the vegetation.The operation was successful. The postoperative period was uneventful. On the follow-up she had no complaints.In cases with Brucella endocarditis, after diagnosis, antibiotic therapy must be started immediately and when the clinical condition improves, surgical intervention should be performed when indicated. (Jpn Heart J 2004; 45: 353-358)

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Surgical treatment of brucella endocarditis

Cited by 41 publications

References 14 publications

Brucella endocarditis in prosthetic valves

Brucella endocarditis in prosthetic valves

Detached mechanical prosthesis due to Brucella endocarditis

A Case of Mitral Stenosis Complicated With Seronegative Brucella Endocarditis

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