Native valve Brucella endocarditis.
OBJECTIVE
Brucellosis is frequently seen in Mediterranean and Middle East countries, including Turkey. We report the medical and surgical management of 31 cases of native endocarditis.


METHODS
Thirty-one patients were admitted to our clinic with suspected Brucella Endocarditis. The diagnosis was established by either isolation of Brucella species, or the presence of antibodies. Following preoperative antibiotic therapy patients underwent valve replacement with excessive tissue debridement. Patients were followed up with Brucella titers, blood cultures, and echocardiography.


RESULTS
On admission all patients were febrile and mostly dyspneic (NYHA Class 3 or 4). The blood tests were normal except for elevated ESR, CRP and serological tests. The aortic valve was involved in 19 patients, mitral valve in 7 patients, and both valves in 5. After serological confirmation of BE, antibiotic therapy was maintained. Twenty-five of the patients received rifampicine, doxycycline, and cotrimaxozole; 2 of them received a combination of rifampicine, streptomycin, and doxycycline; and 4 of them received rifampicine, tetracycline, and cotrimaxozole. Tissue loss in most of the affected leaflets and vegetations were presenting all patients. Valve replacements were performed with mechanical and biologic prostheses. All the patients were afebrile at discharge but received the antibiotics for 101, 2+/-16, 9 days. The follow-up was 37, 1+/-9, 2 months.


CONCLUSIONS
In our retrospective study, combination of adequate medical and surgical therapy resulted in declined morbidity and mortality rate. The valve replacement with aggressive debridement is the most important part of the treatment, which should be supported with efficient preoperative and long term postoperative medical treatment.
Inan
Mustafa Bahadir
MB
Department of Cardiovascular Surgery, Ankara University School of Medicine, Ankara, Turkey. mbahadirinan@gmail.com
Eyileten
Zeynep Bastuzel
ZB
Ozcinar
Evren
E
Yazicioglu
Levent
L
Sirlak
Mustafa
M
Eryilmaz
Sadik
S
Akar
Ruchan
R
Uysalel
Adnan
A
Tasoz
Refik
R
Eren
Neyyir Tuncay
NT
Aral
Atilla
A
Kaya
Bulent
B
Ucanok
Kemalettin
K
Corapcioglu
Tumer
T
Ozyurda
Umit
U
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D001705:Bioprosthesis; D002006:Brucellosis / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000628:therapy*; D003131:Combined Modality Therapy; D003646:Debridement; D004359:Drug Therapy, Combination; D017548:Echocardiography, Transesophageal; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000628:therapy*; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000628:therapy*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D011474:Prosthesis Design; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014421:Turkey / Q000453:epidemiology; D055815:Young Adult
D000900:Anti-Bacterial Agents