Brucella endocarditis - a registry study.
BACKGROUND
A zoonotic infection caused by Brucella spp., brucellosis, is endemic in some areas of the world, like in our country. One of the most devastating conditions related to this infection is endocarditis, although it is rare. Unfortunately, adequate studies on the characteristics of Brucella endocarditis have not been performed. In addition, there was no consensus on optimal type and duration of medical and interventional therapies.


OBJECTIVE
To answer the following questions: what are the clinical characteristics of Brucella endocarditis, which type of therapy should be performed, and can an alternative antibiotic regimen be applied?


METHODS
Patients with the diagnosis of Brucella endocarditis were included in the study during a 6-year period. A total of 10 patients were interrogated for their signs, symptoms, drug use, and clinical conditions. In addition, baseline clinical and laboratory characteristics of the patients were evaluated.


RESULTS
All patients in the study were male with a mean age of 55.9 +/- 12.7 years. Hospitalisation and total follow-up periods were 52.6 +/- 11.2 and 80.6 +/- 29.0 days, respectively. The most frequently presenting symptom was fever (60%). Dyspnoea and fatigue were the other frequent symptoms in descending order. Valve pathology was present in 70% of the study population. The aortic valve was affected more than the mitral valve. Affected mitral valves had rheumatic disease whereas only 57% of the aortic valves had underlying pathology. Isolation of Brucella spp. was possible in 20% of the patients. Mortality rate was 30% in our study; 20% of the patients were on medical follow-up without disease progression and with clinical stability, 60% of patients were on a combination therapy with a tetracycline group, a rifampicin, and a third-generation cephalosporin. Patients who took this combination and underwent aortic valve replacement had good clinical results with a mortality rate of 20%. The 30% of patients were on a combination therapy with a tetracycline group, rifampicin, and an aminoglycoside group. Mortality rate with this combination was 33%, although the success rate was 67%.


CONCLUSIONS
Brucella endocarditis should be considered in the differential diagnosis in patients with vegetations on the cardiac valves, especially in endemic areas. Optimal therapy seems to be a combination of antibiotics and surgery, although medical therapy can be an alternative, especially in stable patients. Addition of a third-generation cephalosporin instead of aminoglycoside to the combination therapy is an alternative.
Department of Cardiology, Yuksek Ihtisas Heart-Education and Research Hospital, 06480, Ankara, Turkey. cayserkan@yahoo.com
Serkan
S
Cay
Goksel
G
Cagirci
Orhan
O
Maden
Yucel
Y
Balbay
Sinan
S
Aydogdu
D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002006:Brucellosis / Q000175:diagnosis* / Q000628:therapy*; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D018450:Disease Progression; D017548:Echocardiography, Transesophageal / Q000379:methods; D004697:Endocarditis, Bacterial / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012042:Registries; D016019:Survival Analysis; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents