Clinical characteristics and outcome of Brucella endocarditis

Background/aim: Brucella endocarditis, which is a rare condition, is the most common cause of death in human brucellosis, leading to severe cardiac complications. By collecting and analyzing clinical cases, we analyzed the clinical characteristics and outcome of Brucella endocarditis in endemic areas in China. Materials and methods: Presented here are 5 cases of Brucella endocarditis, all managed uniformly. We present the clinical, serological, and echocardiographic features; the therapeutic approach; and the follow-up of five patients with Brucella endocarditis. Results: There was a predominance of aortic involvement (4 cases) and a high incidence of left ventricular failure (5 cases). Polymerase chain reaction (PCR) testing was positive in all five patients. Diagnostic suspicion was essential in order to test blood cultures correctly, which in this series were positive in 3 patients. In the follow-up postoperative period of a minimum of 24 months, the patients suffered rare relapse in terms of either the infection or the dysfunction in terms of prosthesis after 3-month antibiotic therapy, with only one exception that died within that period. Conclusion: We should pay attention to Brucella infections and strengthen public awareness and education. It is necessary to screen for and recognize Brucella endocarditis cases early and to provide adequate antibiotic treatment.

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1. Correa de Sa DD, Tleyjeh IM, Anavekar NS, Schultz JC, Thomas JM, Lahr BD. Epidemiological trends of infective endocarditis: a population-based study in Olmsted County, Minnesota. Mayo Clin Proc 2010; 85: 422-426.
2. Duval X, Delahaye F, Alla F, Tattevin P, Obadia JF, Le Moing V, Doco-Lecompte T, Celard M, Poyart C, Strady C et al. Temporal trends in infective endocarditis in the context of prophylaxis guideline modifications: three successive population-based surveys. J Am Coll Cardiol 2012; 59: 1968-1976.
3. Federspiel JJ, Stearns SC, Peppercorn AF, Chu VH, Fowler VG, Jr. Increasing US rates of endocarditis with Staphylococcus aureus: 1999-2008. Arch Intern Med 2012; 172: 363-365.
4. Sy RW, Kritharides L. Health care exposure and age in infective endocarditis: results of a contemporary population-based profile of 1536 patients in Australia. Eur Heart J 2010; 31: 1890- 1897.
5. Murdoch DR, Corey GR, Hoen B, Miro JM, Fowler VG Jr, Bayer AS, Karchmer AW, Olaison Lars, Pappas PA, Moreillon P et al. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study. Arch Intern Med 2009; 169: 463-473.
6. Valliattu J, Shuhaiber H, Kiwan Y, Araj G, Chugh T. Brucella endocarditis. Report of one case and review of the literature. J Cardiovasc Surg (Torino) 1989; 30: 782-785.
7. Al Dahouk S, Nockler K. Implications of laboratory diagnosis on brucellosis therapy. Expert Rev Anti Infect Ther 2011; 9: 833-845.
8. Cacho JB, Aguirre PM, Hernanz A, Velasco AC. Evaluation of a disk method for detection of hippurate hydrolysis by Campylobacter spp. J Clin Microbiol 1989; 27: 359-360.
9. Durack DT, Lukes AS, Bright DK. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. Am J Med 1994; 96: 200- 209.
10. Sasmazel A, Baysal A, Fedakar A, Bugra O, Ozkokeli M, Buyukbayrak F, Keles C, Göçer S, Sunar H, Zeybek R. Treatment of brucella endocarditis: 15 years of clinical and surgical experience. Ann Thorac Surg 2010; 89: 1432-1436.
11. Inan MB, Eyileten ZB, Ozcinar E, Yazicioglu L, Sirlak M, Eryilmaz S, Akar R, Uysalel A, Tasoz R, Tuncay Eren N et al. Native valve brucella endocarditis. Clin Cardiol 2010; 33: E20- 26.
12. Pappas G, Papadimitriou P, Akritidis N, Christou L, Tsianos EV. The new global map of human brucellosis. Lancet Infect Dis 2006; 6: 91-99.
13. Ulu-Kilic A, Metan G, Alp E. Clinical presentations and diagnosis of brucellosis. Recent Pat Antiinfect Drug Discov 2013; 8: 34-41.
14. Pappas G, Akritidis N, Bosilkovski M, Tsianos E. Brucellosis. N Engl J Med. 2005; 352: 2325-2336.
15. Young EJ. Serologic diagnosis of human brucellosis: analysis of 214 cases by agglutination tests and review of the literature. Rev Infect Dis 1991; 13: 359-372.
16. Ariza J, Pellicer T, Pallares R, Foz A, Gudiol F. Specific antibody profile in human brucellosis. Clin Infect Dis 1992; 14: 131-140.
17. Colmenero JD, Reguera JM, Martos F, Sanchez-De-Mora D, Delgado M, Causse M, Martin-Farfan A, Juarez C. Complications associated with Brucella melitensis infection: a study of 530 cases. Medicine (Baltimore) 1996; 75: 195-211.
18. Jeroudi MO, Halim MA, Harder EJ, Al-Sibai MB, Ziady G, Mercer EN. Brucella endocarditis. Br Heart J 1987; 58: 279- 283.
19. Jacobs F, Abramowicz D, Vereerstraeten P, Le Clerc JL, Zech F, Tbys JP. Brucella endocarditis: the role of combined medical and surgical treatment. Rev Infect Dis 1990; 12: 740-744.
20. Berbari EF, Cockerill FR 3rd, Steckelberg JM. Infective endocarditis due to unusual or fastidious microorganisms. Mayo Clin Proc 1997; 72: 532-542.
21. Peery TM, Belter LF. Brucellosis and heart disease. II. Fatal brucellosis: a review of the literature and report of new cases. Am J Pathol 1960; 36: 673-697.
22. Keleş C, Bozbuğa N, Şişmanoğlu M, Güler M, Erdoğan HB, Akinci E, Yakut C. Surgical treatment of brucella endocarditis. Ann Thorac Surg 2001; 71: 1160-1163.
23. Colmenero Castillo JD, Hernandez Marquez S, Reguera Iglesias JM, Cabrera Franquelo F, Rius Diaz F, Alonso A. Comparative trial of doxycycline plus streptomycin versus doxycycline plus rifampin for the therapy of human brucellosis. Chemotherapy 1989; 35: 146-152.