Kaya ZEKERİYA, Ali YILDIZ, Biçer Asuman YEŞİLAY, Aydemir KOÇASLAN, Mehmet Salih AYDIN, Yusuf SEZEN, Ramazan ASOĞLU, Özgür GÜNEBAKMAZ, Recep DEMİRBAĞ

Merkezimizde takip edilen her üç enfektif endokardit olgusundan birisi Brusella endokarditidir

Bu 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

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

The 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 echocardiography. In bacterial cultures, brucella were isolated the most common bacteria (33%). Staphylococcus (21%) and Streptococcus (17%) was positive in cultures and in 5 (20.8%) cases were culture negative. Nine patients (37.4%) underwent surgical treatment. 50% of the native aortic valve, aortic valve replacement 12.5%, 25% and 12.5% of the prosthetic mitral valve and native mitral valve was patients with the diagnosis of brucellosis. Clinical signs of brucella endocarditis were similar with EE. Surgery and medical treatment are the most commonly used treatment in brucella endocarditis. Young age (mean age, 38.9 years), aortic involvement (62.5%), native valve involvement (62.5%), prolonged incubation period (average 10 days) were features of Brucella endocarditis. The characteristics of EE showed similar to literature results. At our center 1/3's EE patients were seen due to Brucella bacteries. Brucella endocarditis should be considered features young age, aortic involvement, native valvuler involvement and long incubation period.

Keywords:

Brucella endocarditis; infective endocarditis.,

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