Treatment of Brucella Endocarditis: Our Surgical Experience with 6 Patients

Authors

  • Mehmet Ozkokeli
  • Yavuz Sensoz
  • Ilyas Kayacioglu
  • Murat Akcar
  • Ismail Erdem
  • Hakan Gercekoglu
  • Sabri Dagsali
  • Ibrahim Yekeler

DOI:

https://doi.org/10.1532/HSF98.20041170

Abstract

Background: Endocarditis is a rare but life-threatening complication of brucellosis. Its mortality rate has recently been reduced with the use of combined medical and surgical treatment.

Methods: Between March 2002 and April 2004, 6 patients with Brucella endocarditis underwent surgery at the Siyami Ersek Cardiovascular Center in Istanbul, Turkey. The diagnosis of Brucellosis was based on the presence of clinical signs and symptoms compatible with brucellosis, serology and/or a positive blood culture. All patients with suspected Brucella endocarditis were studied by echocardiography. The diagnosis of Brucella endocarditis was made in accordance with Duke's criteria.

Results: The most commonly affected valve was the aortic valve (4 patients). Four patients had prosthetic valves because of a previous history of rheumatic fever. In 5 patients, elective surgery was performed. Five patients underwent valve replacement with prosthetic valves, but 1 patient underwent excision of the abscess cavity without valve replacement. There was no operative mortality. All patients continued antibiotic treatment for at least 3 months postoperatively. The median duration of follow-up after surgery was 12 months. During the follow-up period, 1 patient died, while the others remained alive with no recurrences.

Conclusion: Prosthetic valve replacement is a safe procedure in patients with Brucella endocarditis. Surgical interventions combined with triple antibiotic therapy yield good results with no recurrence in the long-term follow-up.

References

Reguera JM, Alarcon A, Miralles F, Pachon C, Juarez C, Colmenero JD. 2003. Brucella endocarditis: clinical, diagnostic, and therapeutic approach. Eur J Clin Microbiol Infect Dis 22:647-50.nAl-Harthi SS. 1989. The morbidity and mortality pattern of Brucella endocarditis. Int J Cardiol 25:321-4.nLubani M, Sharda D, Helin I. 1986. Cardiac manifestations in brucellosis. Arch Dis Child 61:569-72.nKeles C, Bozbuga N, Sismanoglu HB, et al. 2001. Surgical treatment of Brucella endocarditis. Ann Thorac Surg 71:1160-3.nSolera J, Martinez-Alfaro E, Espinosa A. 1997. Recognition and optimum treatment of brucellosis. Drugs 53:245-56.nUddin MJ, Sanyal SC, Mustafa AS, et al. 1998. The role of aggressive medical therapy along with early surgical intervention in the cure of Brucella endocarditis. Ann Thorac Cardiovasc Surg 4:209-13.nQuiroga J, Miralles A, Farinola T, et al. 1996. Surgical treatment of Brucella endocarditis. Cardiovasc Surg 4:227-30.nHall WH. 1990. Modern chemotherapy for brucellosis in humans. Rev Infect Dis 12:1060-99.nFood and Agricultural Organization-World Health Organization. 1986. FAO-WHO Expert Committee on Brucellosis, 6th report. WHO Tech. Rep. Ser. 740:56-7.nAriza J, Gudiol F, Pallares R, Rufi G, Fernandez Viladrich P. 1985. Comparative trial of rifampin-doxycycline versus tetracycline-streptomycine in the therapy of human brucellosis. Antimicrob Agents Chemother 28:548-51.nShamelian SOA. 2000. Diagnosis and treatment of brucellosis. The Netherlands Journal of Medicine 56:198-9.nReguera JM, Alarcon A, Miralles F, Pachon J, Juarez C, Colmenero JD. 2003. Brucella endocarditis: clinical, diagnostic, and therapeutic approach. Eur J Clin Microbiol Infect Dis 22:647-50.nGuerrero MLF. 1993. Zoonotic endocarditis. Infect Dis Clin North Am 3:135-52.nHaydock D, Barratt-Boyes B, Macedo T, Kirklin JW, Blackstone E. 1992. Aortic valve replacement for active infectious endocarditis in 108 patients. J Thorac Cardiovasc Surg 103:130-9.nMcGiffin DC, Galbraith AJ, Lachlan GJ, et al. 1992. Aortic valve infection. J Thorac Cardiovasc Surg 104:511-20.nDuran E, Sunar H, Ege T, Canbaz S. 2001. Exicision of aortic vegetation in Brucella endocarditis. Asian Cardiovasc Thorac Ann 9:59-61.nReport of the WHO working group meeting on brucellosis control and research. Geneva, Switzerland, WHO/CDS/VPH/92.109, June 2-4, 1992.nKarabay O, Sencan I, Kayas D, Sahin I. 2004. Ofloxacin plus Rifampicin versus Doxycycline plus Rifampicin in the treatment of brucellosis: a ran domized clinical trial. BMC Infect Diseases 4:18.nJacobs F, Abramowicz D, Vereerstraeten P, Le Clerck JL, Zech F, Thys JP. 1990. Brucella endocarditis: the role of combined medical and surgical treatment. Rev Infect Dis 12:740-4.nAl-Kasab S, Al-Fagih MR, Al-Yousef S, et al. 1988. Brucella infective endocarditis - successful combined medical and surgical therapy. J Thorac Cardiovasc Surg 95:862-7.nAygen B, Doganay M, Sümerkan B, Yildiz O, Kayabas ü. 2002. Clinical manifestations, complications and treatment of brucellosis. Médecine et Maladies Infectious 32:485-93.nAriza J. 1996. Brucellosis. Curr Opin Infect Dis 9:126-31.nDuract DT, Lukes AS, Bright DK. 1994. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Am J Med 96:200-9.nSaadeh AM, Abu-Farsakh NA, Omari HZ. 1996. Infective endocarditis and occult splenic abscess caused by Brucella melitensis infection: a case report and review of the literature. Acta Cardiol 3:279-85.nPeery TM, Belter LF. 1960. Brucellosis and heart disease. II. Fatal brucellosis: a review of the literature and report of new cases. Am J Pathol 36:673-97.nLeandro J, Roberto H, Antunes M. 1998. Brucella endocarditis of the aortic valve. Eur J Cardio-thoracic Surg 13:95-7.nHalim M, Jeroudi M, Mercer E, et al. 1986. Infective endocarditis in King Faisal Specialist Hospital, review of 35 consecutive adult patients. Ann Saudi Med 6:179-83.nRenzulli A, Gregorio R, Romano GP, et al. 1999. Brucella endocarditis: seven cases treated surgically. Asian Cardiovasc Thorac Ann 7:272-5.nMemish ZA, Almuneef M, Mah MW, Qassem LA, Osoba AO. 2002. Comparison of the Brucella standard agglutination test with the Elisa Ig G and Ig M in patients with brucella bacteremia. Diag Microbiol Infect Dis 44:129-32.nBayer AS, Bolger AF, Taubert KA, et al. 1998. Diagnosis and management of infective endocarditis and its complications. Circulation 29:2936-48.nPedersen WR, Walker M, Olson JD, et al. 1991. Value of transesophageal echocardiography as an adjunct to transthoracic echocardiog-raphy in evaluation of native and prosthetic valve endocarditis. Chest 100:351-6.nRohmann S, Seifert T, Erbel R, et al. 1991. Identification of abscess formation in native-valve endocarditis using transesophageal echocardiography: implications for surgical treatment. Thorac Cardiovasc Surg 39:273-80.nKaralis DG, Bansal RC, Hauck AJ, et al. 1992. Transesophageal echocar-diographic recognition of subaortic complications in aortic valve endocarditis: clinical and surgical implications. Circulation 86:353-62.nDaniel WG, Mugge A, Martin RP, et al. 1991. Improvement in the diagnosis of abscesses associated with endocarditis by Transesophageal echocardiography. N Engl J Med 324:795-800.n

Published

2005-07-07

How to Cite

Ozkokeli, M., Sensoz, Y., Kayacioglu, I., Akcar, M., Erdem, I., Gercekoglu, H., Dagsali, S., & Yekeler, I. (2005). Treatment of Brucella Endocarditis: Our Surgical Experience with 6 Patients. The Heart Surgery Forum, 8(4), E262-E265. https://doi.org/10.1532/HSF98.20041170

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