title: Brucella endocarditis in a non-endemic area presenting as pyrexia of unknown origin.
abstract: A 67-year-old man with type 2 diabetes mellitus and hypertension since 7 years presented with a 3-month history of low-grade fever and malaise. Cardiac auscultation revealed the presence of an ejection systolic murmur in the primary aortic area. Most of the investigations for febrile illness were reported normal. His two-dimensional (2D) echocardiogram revealed a calcified aortic valve with mild aortic stenosis. In view of the prolonged fever and calcified aortic valve with mild aortic stenosis, a transoesophageal echocardiogram was performed, which showed small vegetation noted on right coronary cusp about 2.2 mm with free independent mobility. Blood culture was positive for Brucella spp from all the three venepuncture sites. Medical therapy for brucellosis was given with ciprofloxacin, doxycycline, co-trimoxazole and streptomycin, resulting in complete recovery. Brucella endocarditis is a rare, mostly ignored and missed clinical infection. It requires a high index of clinical suspicion for prompt diagnosis and treatment.
authors.affiliation: Department of Medicine, Padmashree Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India.
authors.forename: Vivek Vilas
authors.initials: VV
authors.lastname: Manade
authors.affiliation: Department of Medicine, Padmashree Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India.
authors.forename: Arjun
authors.initials: A
authors.lastname: Kakrani
authors.affiliation: Department of Medicine, Padmashree Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India.
authors.forename: Siddharth Narayan
authors.initials: SN
authors.lastname: Gadage
authors.affiliation: Department of Microbiology, Padmashree Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India.
authors.forename: Rabindra
authors.initials: R
authors.lastname: Misra
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001021:Aortic Valve / Q000473:pathology; D016470:Bacteremia / Q000382:microbiology*; D002002:Brucella; D002006:Brucellosis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D004697:Endocarditis, Bacterial / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D004699:Endocardium / Q000382:microbiology / Q000473:pathology; D005334:Fever / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008297:Male; D009206:Myocardium / Q000473:pathology
chemical_list: D000900:Anti-Bacterial Agents