Aortic valve endocarditis and cerebral mycotic aneurysm due to brucellosis

Abstract

Brucellosis is an infectious disease caused by Gram-negative coccobacilli. Direct contact with the infected tissue or blood, consumption of infected dairy products, and inhalation of infectious aeresol particles can transmit the disease. Brucella endocarditis is rare but the most fatal complication of brucellosis. The most commonly involved valve is aortic valve. Mycotic aneurysms result as an involvement of central nervous system and can lead to serious complications. Herein we present a case with mycotic aneurysmal rupture and aortic insufficency and sinus valsalva fistula caused by brucella endocarditis. There were rare cases with brucella endocarditis and mycotic aneursymal rupture secondary to neurobrucellosis in the literature. Relevant complications are treated with aortic valve surgery and peripheral endovascular intervention.

Neurobrucellosis

“…Behavioral changes 60% [29] Meningitis 50% [18] Peripheral neuropathy 18--35.2% [33,34] Cranial neuropathies 19% [16] Myelopathy 5--17% [16,31,32] Cerebrovascular complications 16% [23] Seizures 3--11% [16,19 mycotic aneurysms or thrombotic obliteration or septic emboli from endocarditis [16,24,25]. Most importantly, brucellosis should be considered in the differential diagnosis of acute vascular lesions in endemic areas [16].…”

“…In a group of 263 patients enrolled in the Istanbul-3 study, the prevalence of vascular complications detected on imaging was 16%, ischemic lesions being the most common [23]. Possible mechanisms include vasculitis leading to development of mycotic aneurysms or thrombotic obliteration or septic emboli from endocarditis [16,24,25]. Most importantly, brucellosis should be considered in the differential diagnosis of acute vascular lesions in endemic areas [16].…”