Treatment of Brucella endocarditis: our surgical experience with 6 patients.
BACKGROUND
Endocarditis is a rare but life-threatening complication of brucellosis. Its mortality rate has recently been reduced with the use of combined medical and surgical treatment.


METHODS
Between March 2002 and April 2004, 6 patients with Brucella endocarditis underwent surgery at the Siyami Ersek Cardiovascular Center in Istanbul, Turkey. The diagnosis of Brucellosis was based on the presence of clinical signs and symptoms compatible with brucellosis, serology and/or a positive blood culture. All patients with suspected Brucella endocarditis were studied by echocardiography. The diagnosis of Brucella endocarditis was made in accordance with Duke's criteria.


RESULTS
The most commonly affected valve was the aortic valve (4 patients). Four patients had prosthetic valves because of a previous history of rheumatic fever. In 5 patients, elective surgery was performed. Five patients underwent valve replacement with prosthetic valves, but 1 patient underwent excision of the abscess cavity without valve replacement. There was no operative mortality. All patients continued antibiotic treatment for at least 3 months postoperatively. The median duration of follow-up after surgery was 12 months. During the follow-up period, 1 patient died, while the others remained alive with no recurrences.


CONCLUSIONS
Prosthetic valve replacement is a safe procedure in patients with Brucella endocarditis. Surgical interventions combined with triple antibiotic therapy yield good results with no recurrence in the long-term follow-up.
Ozkokeli
Mehmet
M
Cardiovascular Surgery, Izzet Baysal Medical Faculty, Abant Izzet Baysal University, Bolu, Turkey. ozkokeli@yahoo.com
Sensoz
Yavuz
Y
Kayacioglu
Ilyas
I
Akcar
Murat
M
Erdem
Ismail
I
Gercekoglu
Hakan
H
Dagsali
Sabri
S
Yekeler
Ibrahim
I
D000328:Adult; D000368:Aged; D002006:Brucellosis / Q000188:drug therapy / Q000601:surgery*; D003131:Combined Modality Therapy; D004318:Doxycycline / Q000627:therapeutic use; D004697:Endocarditis, Bacterial / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D012293:Rifampin / Q000627:therapeutic use; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D004318:Doxycycline; D012293:Rifampin