Native and Prosthetic Valve Endocarditis Caused by Brucella spp.; Evaluation of Eight Cases

Abstract

Brucellosis and its complications are still a problem in developing countries. All cases of infective endocarditis admitted to Siyami Ersek Thoracic and Cardiovascular Surgery Hospital were recorded prospectively between July 2000 and July 2004. A total of 88 cases with infective endocarditis were recorded and 8 (9%) of these patients were identified as having endocarditis caused by Brucella spp. Underlying heart diseases were prosthetic valve in five patients and native valve sequele secondary to acute reumatic fever in three. All of the patients had positive results of Wright agglutination test with titers greater than 1/1280. Brucella melitensis were isolated in blood cultures of six patients. Vegetation, abscess, corda rupture and new dehiscence of prosthetic valve have been seen either by TTE or TEE in eight, five, one and one of eight patients respectively. Although TTE were found to be normal, TEE revealed vegetation in four (three prosthetic, one native valve) of eight patients. All of the patients were treated with trimethoprim-sulfamethoxazole, rifampin and doxycycline combination for 12 months. Surgical intervention was done for seven patients within a median of 18 days (range 7-45 day), and patients were alive after 12 months follow up. Brucella spp. should be considered in patients with infective endocarditis, especially in countries where the diseas still endemic. TEE should be done in case of normal TTE findings. Early surgical intervention can reduce mortality