Conservative treatment for <i>brucella</i> endocarditis

Cohen, Natan; Golik, Ahuva; Alon, Irena; Zaidenstein, Ronit; Dishi, Victor; Modai, David; Karpuch, J; Zyssman, Itzchak

doi:10.1002/clc.4960200319

Cited by 45 publications

(28 citation statements)

References 18 publications

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“…The accepted treatment for BE is a combination of medical and surgical interventions. (6,8,11,12) Although conservative antibiotic treatment alone is considered ineffective, and has not been recommended by most authors for this reason, a complete cure has been reported in a few cases of BE (13,14) using this method. Patients who may be suitable for this kind of treatment are those with congestive heart failure, relatively mild extravalvular involvement and a short symptomatic period before antibiotic therapy begins.…”

Section: Discussionmentioning

confidence: 99%

Brucella Endocarditis: A Case Study

Kušljugić¹,

Kovačević²

2015

Scientific Symposium Acquired Heart Diseases. World Heart Day 2014. Proceedings

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Endocarditis is a rare and serious complication of brucellosis and is the main cause of death in this pathology. Diagnosis requires a high level of attention, and is based on the association of epidemiological, clinical and serological elements. Echocardiography plays a crucial role in early diagnosis, as well as in identifying a predisposition to heart disease and local complications typical of this pathology. This case study follows a case of Brucella endocarditis involving the aortic valve, in a 39-year-old male, diagnosed in October 2010. Despite being given complete pharmaceutical treatment, in this instance emergency heart surgery was necessary, due to an inability to control the infection and subsequent changes in the patient's condition, which were leading to congestive heart failure. Aggressive treatment, with surgery performed during a period of active infection, produced good results in the eradication of infection, and in preventing fatal complications. The patient is now fully recovered, and was given triple therapy for brucellosis according to existing recommendations.

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Section: Discussionmentioning

confidence: 99%

Brucella Endocarditis: A Case Study

Kušljugić¹,

Kovačević²

2015

Scientific Symposium Acquired Heart Diseases. World Heart Day 2014. Proceedings

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“…Because relapses may occur two years after a supposed cure, an attempt of medical treatment without surgical intervention absolutely requires careful monitoring under therapy, as well as strict and prolonged clinical and echocardiographic surveillance (21,37). Regarding these prerequisites, a conservative antibiotic treatment may be an appropriate alternative to surgery in selected patients, but in prosthetic valve endocarditis, surgical replacement is generally recommended (7,8,39). In brucellosis patients with a history of valvular heart disease, frequent echocardiographic studies are mandatory (12).…”

Section: Discussionmentioning

confidence: 99%

“…In adults, however, triple or quadruple combinations in high dosages over a prolonged course (longer than 12 weeks) are necessary for successful treatment of Brucella endocarditis. Trimethoprim-sulfamethoxazole (trimethoprim 400 mg/day, sulfamethoxazole 2400 mg/day) and/or rifampin (600 mg/day to 900 mg/day) are used in addition to the traditional antimicrobial agents (ie, doxycycline [2 × 100 mg/day] in combination with an aminoglycoside [streptomycin 1 g/day or gentamicin 240 mg/day]) (5,7,8,11,24,39). Because no general recommendations exist for how long antimicrobial agents should be administered, clinical, serological and microbiological findings may help the physician to decide whether antibiotic treatment should be continued.…”

Section: Discussionmentioning

confidence: 99%

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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“…3,11) Medical treatment consists of combined administration of streptomycin, tetracycline, rifampicin, doxycycline, or ciprofloxocin for at least 6 weeks, although medical therapy alone is not effective in most cases. 10,12,13) Ciprofloxocin is the most effective antibiotic against Brucella melitensis.…”

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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Conservative treatment for brucella endocarditis

Cited by 45 publications

References 18 publications

Brucella Endocarditis: A Case Study

Brucella Endocarditis: A Case Study

Brucella endocarditis in prosthetic valves

A Case of Mitral Stenosis Complicated With Seronegative Brucella Endocarditis

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