Native and prosthetic valve endocarditis caused by Brucella Spp.: evaluation of eight cases

Abstract number: 1134_01_180

Kocak F., Simsek Yavuz S.

Objectives:  

Brucellosis and its complications are still a problem in developing countries. Eight cases of infective endocarditis caused by Brucella spp. were reported.

Material and methods:  

All cases of infective endocarditis were recorded in previously prepared forms prospectively between January 2000 and January 2004 by one of the authors. Duke Criteria were used for the diagnosis of infective endocarditis. BACTEC 9240 Becton Dickinson blood culture system were used for the incubation of blood bottles. Identification of microorganisms were done with classical methods and anti sera were used for Brucella melitensis (Murex Biotech Lmtd. UK, Lot No: CM02).

Results:  

A total of 88 cases with infective endocarditis were recorded and 8 of these (9%) patients were identified as having endocarditis caused by Brucella spp. Six patients were male and two were female. Median age was 44 (range) and median time from the beginning of complaints to the admittance to the hospital was 17 days (range 5–60 days). Underlying heart diseases were prosthetic valve in 5 patients and native valve sequel secondary to acute rheumatic fever in 3. Splenomegali and hepatomegali were found in 6 patients. Osler node and janeway lesion were found in only one patient. Romatoid factor were found to be positive in 3 patients. All of the patients had positive results of Wright agglutination with titres greater than 1/1280. Brucella melitensis were isolated in blood cultures of 6 patients. Vegetation, abscess, corda rupture and new dehiscence of prosthetic valve have been seen either TEE or TTE in 8, 5, 1 and 1 of 8 patients respectively. Although TTE were found to be normal, TEE revealed vegetation in 4 (3 prosthetic, one native valve) of 8 patients. Diagnosis of infective endocarditis was definite in all of the cases. All of the patients were treated with trimetoprim–sulfametaxazole, rifampicin and doxycyclin combination for 12 months. Surgical intervention was done for 7 patients within a median of 18 days (range 7–45). All of the patients were alive after 12 months of follow up.

Conclusions:  

Brucella spp. should be considered in patients with infective endocarditis, especially in countries where the disease still endemic. TEE should be done in case of normal TTE findings. Early surgical intervention can reduce mortality.