title: Native valve Brucella endocarditis.
abstract: 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.
authors.affiliation: Department of Cardiovascular Surgery, Ankara University School of Medicine, Ankara, Turkey. mbahadirinan@gmail.com
authors.forename: Mustafa Bahadir
authors.initials: MB
authors.lastname: Inan
authors.forename: Zeynep Bastuzel
authors.initials: ZB
authors.lastname: Eyileten
authors.forename: Evren
authors.initials: E
authors.lastname: Ozcinar
authors.forename: Levent
authors.initials: L
authors.lastname: Yazicioglu
authors.forename: Mustafa
authors.initials: M
authors.lastname: Sirlak
authors.forename: Sadik
authors.initials: S
authors.lastname: Eryilmaz
authors.forename: Ruchan
authors.initials: R
authors.lastname: Akar
authors.forename: Adnan
authors.initials: A
authors.lastname: Uysalel
authors.forename: Refik
authors.initials: R
authors.lastname: Tasoz
authors.forename: Neyyir Tuncay
authors.initials: NT
authors.lastname: Eren
authors.forename: Atilla
authors.initials: A
authors.lastname: Aral
authors.forename: Bulent
authors.initials: B
authors.lastname: Kaya
authors.forename: Kemalettin
authors.initials: K
authors.lastname: Ucanok
authors.forename: Tumer
authors.initials: T
authors.lastname: Corapcioglu
authors.forename: Umit
authors.initials: U
authors.lastname: Ozyurda
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents