Successful management of Brucella mellitensis endocarditis with combined medical and surgical approach.
OBJECTIVE
Brucella endocarditis is an underdiagnosed complication of human brucellosis, associated with high morbidity and mortality. We report the successful management of a number of cases of Brucella mellitensis endocarditis.


METHODS
Seven consecutive cases of Brucella mellitensis endocarditis were treated over the last 20 years, based on high suspicion of the disease at first place. The early suspicion of Brucella endocarditis relied on medical history and a standard tube agglutination titer > or =20. Blood and/or cardiac tissue cultures were positive in all patients, but available late following surgery. All patients were successfully treated with a combination of aggressive medical and early surgical therapy. All affected valves were replaced within 1 week from admission (five aortic and three mitrals). Medical treatment included co-trimoxazole, tetracyclines and streptomycin, before surgery, followed by co-trimoxazole and tetracyclines for a median of 12 months (range: 3-15 months) after surgery until the titers returned to a level < or =1:160.


RESULTS
There were neither operative deaths nor recurrence of infection. One patient died two years after the operation due to massive cerebrovascular accident. Ten-year survival was 85.7+/-13.2%.


CONCLUSIONS
Although Brucella mellitensis endocarditis is a rare entity, its optimum management should be a combination of aggressive medical treatment and early surgical intervention, based on high degree of suspicion in areas with high incidence of the disease.
Hadjinikolaou
L
L
Departments of Cardiology and Cardiothoracic Surgery, University of Thessaly, Larissa, Greece. l_hadjinikolaou@hotmail.com
Triposkiadis
F
F
Zairis
M
M
Chlapoutakis
E
E
Spyrou
P
P
D000328:Adult; D000368:Aged; D017347:Brucella melitensis; D002006:Brucellosis / Q000628:therapy*; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013307:Streptomycin / Q000008:administration & dosage; D015996:Survival Rate; D013752:Tetracycline / Q000008:administration & dosage; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage
D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D013752:Tetracycline; D013307:Streptomycin