Brucella endocarditis complicated with a mycotic aneurysm of the superior mesenteric artery: a case report

Erbay, Ali Rıza; Turhan, Hasan; Doğan, Mehmet; Erbasi, Sakine; Çağlı, Kerim; Sabah, İrfan

doi:10.1016/s0167-5273(03)00166-9

Cited by 20 publications

(13 citation statements)

References 7 publications

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“…Brusella endokarditinde literatürde en sık aortik kapak tutulumu olduğu görülmektedir ve %82'ye varan oranda aortik kapak tutulumu gösterilmiştir ve bizim çalışmamızda bu oran %62,5'tir (19,20). Brusella endokarditinde aortik kapak tutulumu çok sayıda sistemik embolik komplikasyona yol açmaktadır: Süperiyor mezenterik arter anevrizması, miyokardit, splenik apse ve subklavyan arter trombozu gibi pek çok komplikasyon bildirilmiştir (21)(22)(23)(24). Takip ettiğimiz tüm hastalar kapakta vejetasyon ile gelmiş olup, sadece bir hastada periannüler aortik apse de mevcuttu.…”

Section: Discussionunclassified

One of every three cases of infective endocarditis followed in our center is Brucella endocarditis

Kaya¹,

Yıldız²,

Yeşilay³

et al. 2013

Gaziantep Med J

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ÖzetBu çalışma ile hastanemizde takip edilen enfektif endokardit (EE) olgularının epidemiyolojik, klinik, laboratuar özellikleri ile Brusella endokarditinin merkezimizdeki sıklığının ve özelliklerinin belirlenmesi amaçlanmıştır. Çalışmaya, 2008-2012 yılları arasında, kliniğimizde takip edilen ve modifiye Duke kriterlerine göre EE tanısı konulan 24 hasta (12 kadın,12 erkek; ortalama yaş; 41,3 yıl, yaş aralığı; 12-85 yıl) alındı. Hastaların demografik, klinik, ekokardiyografik, laboratuar, tedavi ve takip verileri değerlendirildi. Hastaların 20'sinde (%83,3) doğal kapak, 3'ünde (%12,5) mekanik protez kapak, 1'inde (%4,2) kalıcı kalp pili ile ilişkili EE saptandı. Doğal kapak tutulumunda en sık mitral etkilenmişti (Mitral %45; aortik kapak %35; triküspit kapak %10). Protez kapaklarda da en sık etkilenen kapak mitral kapak (%100) idi. En sık görülen semptomlar arasında ateş (% 66,7), titreme ve terleme (%37,5), halsizlik (%12,5) mevcuttu. Transtorasik ve/veya transözofageal ekokardiyografide en sık bulgu vejetasyondu (%66,6). Kültürlerde en sık Brusella (%33), stafilokok (%21) ve streptokok (%17) üredi; 5 (%20,8) olguda ise üreme olmadı. Toplamda 9 hastaya (%37,4) cerrahi tedavi uygulandı. Brusella tanısı konulanların % 50'si nativ aortik kapak, % 12,5 protez aortik kapak, %25 protez mitral kapak ve % 12,5 nativ mitral kapak idi. Brusella endokarditinin kliniği EE kliniği ile benzerdi. Brusella endokarditinde cerrahi+medikal tedavi en sık uygulanan tedaviydi. Genç yaş (ortalama yaş;38,9 yıl), aortik tutulum (%62,5), nativ kapak tutulum (%62,5), uzun süren inkübasyon periyodu (ortalama 10 gün) Brusella endokarditinin özellikleri arasında idi. EE özellikleri literatürdeki sonuçlar ile benzerlik göstermekteydi. Merkezimizdeki EE hastalarının 1/3'i gibi yüksek oranlarda Brusella endokarditi görülmekteydi. Genç yaş, aortik tutulum, nativ kapak, uzun inkübasyon periyodu gibi özellikleri taşıyan endokarditlerde Brusella endokarditi mutlaka düşünülmelidir. Anahtar kelimeler: Brusella endokarditi; enfektif endokardit. AbstractThe purpose of this study is to determine the epidemiological, clinical and laboratory characteristics and prevalence of Brucella endocarditis followed in our hospital was. The study were included 24 infective endocarditis (EE) patients (12 female, 12 male, mean age, 41.3 years, range, 12-85 years) followed in our clinic between 2008-2012 and diagnosed with modified Duke criteria. The demographic, clinical, echocardiographic, laboratory variables, treatment and follow-up data were evaluated. EE was associated with in 20 patients (83.3%), natural valve, 4 (12.2%), mechanical prosthetic valve and 1 patient (4.2%) a permanent pacemaker. Among natural valves, mitral valve was the most frequently involvement (45% of mitral, aortic 35%, tricuspid valve 10%). Mitral valve was most commonly affected prosthetic valves (100%). The most common symptoms included fever (66.7%), chills and sweating (37.5%), fatigue (12.5%). Vegetation was the most common lesion (66.6%) in transthoracic and/or transesophageal echocard...

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Section: Discussionunclassified

One of every three cases of infective endocarditis followed in our center is Brucella endocarditis

Kaya¹,

Yıldız²,

Yeşilay³

et al. 2013

Gaziantep Med J

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“…Erbay et al presented a case of Brucella melitensis endocarditis complicated with a superior mesenteric artery aneurysm. In that case, since there was no intracardiac complication of Brucella endocarditis, and with medical therapy a significant reduction in the size of the vegetation on the mitral valve leaflets was noticed, they did not perform any cardiac surgery such as mitral valve repair or replacement (9). Medical therapy can be used for patients with mild cardiac involvement and with symptoms of short duration (10,11).…”

Section: Discussionmentioning

confidence: 99%

Presentation of Two Cases Diagnosed with Brucella Endocarditis

Senger

Ersan

et al. 2012

Intern. Med.

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Brucellosis is an important disease in developing countries. Endocarditis is a complication of brucellosis with the highest mortality. Although the most generally accepted therapy is the combination of medication and surgery, it has been reported that antibiotic treatment only might also be adequate. We present two cases for whom antibiotic treatments were initiated, and a follow-up surgery was planned for one of them. The surgery could not be done due to death of the patient, but the other patient fully recovered with antibiotic treatment only. Optimum treatment and prognostic criteria are not well defined for brucella endocarditis, but medical therapy alone can be considered for some chosen patients.

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“…Since Brucella causes a systemic infection, it can also be accompanied by vascular complications from peripheral vasculature. Indeed, a case of B. endocarditis complicated with a mycotic aneurism of the superior mesenteric artery has recently been reported [5], underlining the systemic nature of this infection. Antibiotic therapy alone is usually insufficient in B. endocarditis [1,5].…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, a case of B. endocarditis complicated with a mycotic aneurism of the superior mesenteric artery has recently been reported [5], underlining the systemic nature of this infection. Antibiotic therapy alone is usually insufficient in B. endocarditis [1,5]. However, a few cases of successful conservative antibiotic treatment have been reported in the literature [6].…”

Section: Discussionmentioning

confidence: 99%

“…Generally the valve replacement should take place as soon as possible [1]. The indications for operation are failure of medical treatment, abscess, vegetations developed while receiving antibiotics and Brucella prosthetic valve endocarditis [1,5]. Several combinations of antibiotics have been used successfully in the treatment of B. endocarditis (rifampin, doxycycline, streptomycin and co-trimoxazole).…”

Section: Discussionmentioning

confidence: 99%

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