Brucella arteritis: clinical manifestations, treatment, and prognosis.
Brucellosis is the most common bacterial zoonosis, and causes a considerable burden of disease in endemic countries. Cardiovascular involvement is the main cause of mortality due to infection with Brucella spp, and most commonly manifests as endocarditis, peripheral and cerebrovascular aneurysms, or arterial and venous thromboses. We report a case of brucellosis presenting as bacteraemia and aortic endarteritis 18 years after the last known exposure to risk factors for brucella infection. The patient was treated with doxycycline, rifampicin, and gentamicin, and underwent surgical repair of a penetrating aortic ulcer, with a good clinical recovery. We review the signs and symptoms, diagnostic approach, prognosis, and treatment of brucella arteritis. We draw attention to the absence of consensus about the optimum therapy for vascular brucellosis, and the urgent need for additional studies and renewed scientific interest in this major pathogen.
Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA. Electronic address: christe5@uic.edu.
Jesica A
JA
Herrick
Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, Bethesda, MD, USA.
Robert J
RJ
Lederman
Office of Research Services, National Institutes of Health, Bethesda, MD, USA.
Brigit
B
Sullivan
Scientific Applications International Corporation in support of the Collaborative Clinical Research Branch, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA; George Washington University School of Medicine, Washington, DC, USA.
John H
JH
Powers
Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA.
Tara N
TN
Palmore
D000003:Abattoirs; D000368:Aged; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001018:Aortic Diseases / Q000601:surgery; D016470:Bacteremia / Q000175:diagnosis; D001807:Blood Vessel Prosthesis; D002003:Brucella abortus / Q000302:isolation & purification*; D002006:Brucellosis / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D004318:Doxycycline / Q000627:therapeutic use; D004484:Ecuador / Q000208:ethnology; D004692:Endarteritis / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy; D005839:Gentamicins / Q000627:therapeutic use; D006801:Humans; D008297:Male; D016273:Occupational Exposure; D011379:Prognosis; D012293:Rifampin / Q000627:therapeutic use; D014456:Ulcer / Q000601:surgery
D000900:Anti-Bacterial Agents; D005839:Gentamicins; D004318:Doxycycline; D012293:Rifampin