1
|
Liu J, Wang X, Yang T, Sun L, Xu H, Hao B, Zhang J. Endovascular treatment of aorta-iliac arterial pseudoaneurysm caused by Brucella. Surgery 2024:S0039-6060(24)00284-8. [PMID: 38839433 DOI: 10.1016/j.surg.2024.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/28/2024] [Accepted: 04/22/2024] [Indexed: 06/07/2024]
Abstract
We aimed to analyze the feasibility of endovascular treatment for brucellosis-related aorta-iliac artery pseudoaneurysm. We did a statistical analysis that among the 11 cases, the thoracic aorta was involved in 3 cases, the abdominal aorta was involved in 6 cases, and the iliac artery was involved in 2 cases. Five patients had a history of contact with cattle and sheep, 3 had a history of drinking raw milk, 10 patients had a fever before the operation, and 11 patients had positive serum agglutination test. Blood culture was positive in 2 patients. All patients were given anti-brucellosis treatment immediately after diagnosis. One died of aortic rupture 5 days after emergency endovascular gastrointestinal bleeding. Endovascular-covered stent implantation and active anti-brucellosis therapy were used to treat 10 patients. The follow-up period was 8 years without aortic complications or death for all patients. We think early diagnosis and a combination of anti-brucellosis drugs and endovascular therapy may be the first choice for treating the pseudoaneurysm caused by Brucella.
Collapse
Affiliation(s)
- JiaHao Liu
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, Taiyuan, China
| | - XinYang Wang
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, Taiyuan, China
| | - Tao Yang
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, Taiyuan, China
| | - Lei Sun
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, Taiyuan, China
| | - Huimin Xu
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, Taiyuan, China
| | - Bin Hao
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, Taiyuan, China
| | - JianTao Zhang
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, Taiyuan, China.
| |
Collapse
|
2
|
Li X, Li X, Cheng Z. Brucellosis involving the aorta and iliac arteries: a systematic review of 130 cases. Front Bioeng Biotechnol 2023; 11:1326246. [PMID: 38098968 PMCID: PMC10720085 DOI: 10.3389/fbioe.2023.1326246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/13/2023] [Indexed: 12/17/2023] Open
Abstract
Objective: Brucellosis, the most common bacterial zoonosis, poses a serious threat to public health in endemic regions. Cardiovascular complications of brucellosis, mostly pericarditis or endocarditis, are the leading cause of brucellosis-related death. Complications involving the aorta and iliac arteries are extremely rare but can be life-threatening. Our objective was to identify and review all reported cases of aortic and iliac involvement in brucellosis to provide a deep, up-to-date understanding of the clinical characteristics and management of the disease. Methods: Online searches in PubMed, Web of Science, China National Knowledge Infrastructure, and the Chinese Wanfang database were conducted to collect articles reporting cases of brucellosis with aortic and iliac artery involvement. All data in terms of patient demographics, diagnostic methods, clinical manifestations, and treatment regimens and outcomes were extracted and analyzed in this systematic review. Results: A total of 79 articles were identified, reporting a total of 130 cases of brucellosis with aortic and iliac artery involvement. Of the 130 cases, 110 (84.5%) were male individuals and 100 (76.9%) were over 50 years old. The patients had an overall mortality rate of 12.3%. The abdominal aorta was most commonly involved, followed by the ascending aorta, iliac artery, and descending thoracic aorta. Arteriosclerosis, hypertension, and smoking were the most common comorbidities. There were 71 patients (54.6%) who presented with systemic symptoms of infection at the time of admission. Endovascular therapy was performed in 56 patients (43.1%), with an overall mortality rate of 3.6%. Open surgery was performed in 52 patients (40.0%), with an overall mortality rate of 15.4%. Conclusion: Aortic and iliac involvement in brucellosis is extremely rare but can be life-threatening. Its occurrence appears to be associated with the male gender, an older age, arteriosclerosis, and smoking. Although the number of reported cases in developing countries has increased significantly in recent years, its incidence in these countries may still be underestimated. Early diagnosis and therapeutic intervention are critical in improving patient outcomes. Endovascular therapy has become a preferred surgical treatment in recent years, and yet, its long-term complications remain to be assessed.
Collapse
Affiliation(s)
- Xiao Li
- Department of Vascular Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, China
| | - Xiaoyu Li
- Department of Otolaryngology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Zhihua Cheng
- Department of Vascular Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, China
| |
Collapse
|
3
|
Aortic and iliac involvement in brucellosis –a rare but life-threatening manifestation: A review of the literature. Eur J Vasc Endovasc Surg 2022; 63:743-750. [DOI: 10.1016/j.ejvs.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 01/14/2022] [Accepted: 02/06/2022] [Indexed: 11/18/2022]
|
4
|
Taamallah K, Hammami F, Gharsallah H, Koubaa M, Ben Jemaa M, Fehri W. Brucella Prosthetic Valve Endocarditis: A Systematic Review. J Saudi Heart Assoc 2021; 33:198-212. [PMID: 34447668 PMCID: PMC8366765 DOI: 10.37616/2212-5043.1257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 12/16/2022] Open
Abstract
Objective Brucella prosthetic valve endocarditis is a rare but a life-threatening complication of brucellosis. It remains a diagnostic challenge. Optimal treatment of Brucella prosthetic valve endocarditis is debated. Available data is limited to case reports or small case series. The purpose of this study was to systematically review all published cases of Brucella prosthetic valve endocarditis in the literature. Method A systematic review of PubMed database, Google, Google Scholar, and Scopus (From January 1974 to the present) for studies providing epidemiological, clinical and microbiological data as well as data on treatment and outcomes of Brucella prosthetic valve endocarditis was performed. Results A total of 51 reported cases were reviewed. Brucella melitensis (45%) and Brucella abortus (11.7%) were the most frequently isolated species. Most common type of prosthesis valve was mechanical prothesis (84.3%) and ten patients had double valve prosthesis (19.6%). Fever and dyspnea were present in 100% and 37.2% of the cases, respectively. The diagnosis was set with echocardiographic finding in 30 cases (93.7%), which revealed vegetation in 27 cases (84.3%). Most used antibiotics were rifampicin, doxycycline and aminoglycoside or cotrimoxazole. No deaths were noted in patients treated by combined medical and surgical treatment, but mortality was noted in 27.7% of the cases treated by antibiotics alone (p = 0.006). Conclusion This systematic review highlights diagnostic challenges and demonstrates that surgery improved outcome by reducing mortality in patients treated with the combined surgical and medical treatment option. Brucellosis should be considered in the differential diagnosis of prosthetic valve endocarditis in patients residing in or traveling to areas of endemicity.
Collapse
Affiliation(s)
- Karima Taamallah
- Cardiology Department, Military Hospital of Tunis, Tunis, Tunisia
| | - Fatma Hammami
- Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Hédi Gharsallah
- Intensive Care Unit Department, Military Hospital of Tunis, Tunis, Tunisia
| | - Makram Koubaa
- Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Mounir Ben Jemaa
- Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Wafa Fehri
- Cardiology Department, Military Hospital of Tunis, Tunis, Tunisia
| |
Collapse
|
5
|
Herrick JA, Lederman RJ, Sullivan B, Powers JH, Palmore TN. Brucella arteritis: clinical manifestations, treatment, and prognosis. THE LANCET. INFECTIOUS DISEASES 2014; 14:520-6. [PMID: 24480149 PMCID: PMC4498663 DOI: 10.1016/s1473-3099(13)70270-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
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.
Collapse
Affiliation(s)
- Jesica A Herrick
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA.
| | - Robert J Lederman
- Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, Bethesda, MD, USA
| | - Brigit Sullivan
- Office of Research Services, National Institutes of Health, Bethesda, MD, USA
| | - John H Powers
- 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
| | - Tara N Palmore
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| |
Collapse
|
6
|
Medical versus medical and surgical treatment for brucella endocarditis. Ann Thorac Surg 2012; 94:2141-6. [PMID: 23102495 DOI: 10.1016/j.athoracsur.2012.07.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 07/03/2012] [Accepted: 07/10/2012] [Indexed: 11/22/2022]
Abstract
This review was undertaken to determine the role of surgery in the treatment of brucella endocarditis. All English and French articles reporting brucella endocarditis (1966 to 2011) in PubMed, Google, and Scopus were reviewed. In all, 308 cases were identified, and linear and logistic regression was performed. Surgery improved outcomes by decreasing mortality from 32.7% in the medical treatment only group to 6.7% in the combined surgical and medical treatment group (p<0.001). This association was still significant while controlling for other contributing factors. In the absence of a controlled trial, we recommend the utmost vigilance and consideration of surgical management in treating such patients.
Collapse
|
7
|
Cascio A, De Caridi G, Lentini S, Benedetto F, Stilo F, Passari G, Iaria C, Spinelli F, Pappas G. Involvement of the aorta in brucellosis: the forgotten, life-threatening complication. A systematic review. Vector Borne Zoonotic Dis 2012; 12:827-40. [PMID: 22994597 DOI: 10.1089/vbz.2012.0965] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Human brucellosis is a disease of protean manifestations, and has been implicated in complications and focal disease in many human organ systems. However, little is collectively known about the background, the course, the clinical characteristics, the diagnostic issues raised, and the short- and long-term therapeutic approaches in patients with aortic involvement as a complication of brucellosis. With the aim to glean from the literature useful information to better understand and manage this complication, a computerized search without language restriction was conducted using PubMed and SCOPUS. An article was considered eligible for inclusion in the systematic review if it reported data on patients with involvement of the aorta due to a Brucella infection. The epidemiologic and clinical characteristics of 44 cases of brucellar aortic involvement found through the systematic review of the literature were analyzed together with those of two new cases that we treated in the recent past. This complication involved the ascending thoracic aorta in 18 cases (in 16 of them as a consequence of brucellar endocarditis), and the descending thoracic aorta or the abdominal aorta in the remaining 30 cases. In the latter it was associated with spondylodiscitis of the lumbar spine in 13 cases. History of or symptoms indicative of brucellosis were not universally present. Brucellar aortic involvement represents a possibly underdiagnosed and underreported complication with major morbidity and mortality potential. Experience with novel invasive therapeutic approaches remains limited. Early suspicion through detailed history and diagnosis, aided by advances in aortic imaging, would allow for better planning of therapeutic interventions.
Collapse
Affiliation(s)
- Antonio Cascio
- Department of Human Pathology, Policlinico "G. Martino" University Hospital, University of Messina, Messina, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Amirghofran AA, Karimi A, Emaminia A, Sharifkazemi MB, Salaminia S. Brucellosis relapse causing prosthetic valve endocarditis and aortic root infective pseudoaneurysm. Ann Thorac Surg 2011; 92:e77-9. [PMID: 21958835 DOI: 10.1016/j.athoracsur.2011.03.144] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 03/24/2011] [Accepted: 03/28/2011] [Indexed: 11/26/2022]
Abstract
We report a previously treated case of brucellosis and aortic root replacement, which became complicated by prosthetic valve endocarditis and a massive aortic root pseudoaneurysm. Preoperative blood and intraoperative pseudoaneurysm wall cultures were positive for Brucella, and the patient was managed successfully with a combination of surgical and medical treatment. Brucella endocarditis is further discussed.
Collapse
Affiliation(s)
- Ahmad Ali Amirghofran
- Division of Cardiothoracic Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | | | | |
Collapse
|
9
|
Brucella melitensis Endocarditis Combined With Candida albicans in a Patient With Prosthetic Valves. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2010. [DOI: 10.1097/ipc.0b013e3181e9b6a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
10
|
Sasmazel A, Baysal A, Fedakar A, Buğra O, Ozkokeli M, Büyükbayrak F, Keleş C, Göçer S, Sunar H, Zeybek R. Treatment of Brucella endocarditis: 15 years of clinical and surgical experience. Ann Thorac Surg 2010; 89:1432-6. [PMID: 20417757 DOI: 10.1016/j.athoracsur.2010.01.048] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Revised: 01/25/2010] [Accepted: 01/28/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND Brucella endocarditis is a life-threatening complication of human brucellosis. In this study, our aim was to evaluate the effects of combined medical and surgical treatment in the midterm to long term. METHODS We retrospectively analyzed 13 patients (mean age 44 +/- 18 years; 8 males) who were operated on from January 1993 to June 2009. Duke criteria were used for the diagnosis of endocarditis. The primary endpoint was defined as the overall mortality and readmission to the hospital during early and late follow-up periods. The other collected data included baseline and follow-up clinical findings, along with echocardiographic and laboratory measurements. RESULTS No patients died in the early period (up to 1 month) and 2 patients (15.3%) died during the late follow-up period. Aortic valve disease was observed in 11 of 13 patients (85%). The most commonly performed procedure was aortic valve replacement (10 of 13 patients; 77%) during a mean follow-up period of 95 +/- 60 months (range, 10 to 184; median, 74). CONCLUSIONS For Brucella endocarditis, perioperative antibiotic therapy combined with surgical treatment (prosthetic valve replacement) has satisfactory results and increases the quality of life in the long-term follow-up.
Collapse
Affiliation(s)
- Ahmet Sasmazel
- Department of Cardiovascular Surgery, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Cohen N, Golik A, Alon I, Zaidenstein R, Dishi V, Karpuch J, Zyssman I, Modai D. Conservative treatment for Brucella endocarditis. Clin Cardiol 2009; 20:291-4. [PMID: 9068918 PMCID: PMC6656194 DOI: 10.1002/clc.4960200319] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Endocarditis is the most devastating complication of brucellosis. The accepted treatment for Brucella endocarditis (BE) is a combination of valve replacement and antibiotics. Conservative antibiotic treatment alone is not recommended by most authors, as it is considered ineffective, risking fatality. We describe a patient with BE, in whom antibiotic treatment alone resulted in complete recovery. On reviewing the literature, we found 12 additional such cases. We compared this group of 13 patients with data from 49 published cases treated with a combination of surgery and antibiotics, with a favorable outcome. Absence of congestive heart failure or a prosthetic valve, relatively mild extravalvular cardiac involvement, and a somewhat shorter disease history until initiation of treatment were characteristic of the group treated conservatively in comparison with patients who underwent surgery. In selected patients with BE, conservative antibiotic treatment may be a valid alternative to surgery.
Collapse
Affiliation(s)
- N Cohen
- Department of Internal Medicine "A", Assaf Harofeh Medical Center, Zerifin, Israel
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Murdaca G, Colombo BM, Caiti M, Cagnati P, Massa G, Puppo F. Remission of brucella endocarditis in a patient with mitral valve mechanical prosthesis by antibiotic therapy alone: a case report. Int J Cardiol 2007; 117:e35-6. [PMID: 17275109 DOI: 10.1016/j.ijcard.2006.11.098] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2006] [Accepted: 11/11/2006] [Indexed: 10/23/2022]
|
13
|
Hadjinikolaou L, Triposkiadis F, Zairis M, Chlapoutakis E, Spyrou P. Successful management of Brucella mellitensis endocarditis with combined medical and surgical approach. Eur J Cardiothorac Surg 2001; 19:806-10. [PMID: 11404134 DOI: 10.1016/s1010-7940(01)00696-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Brucella endocarditis is an underdiagnosed complication of human brucellosis, associated with high morbidity and mortality. We report the successful management of a number of cases of Brucella mellitensis endocarditis. PATIENTS AND METHODS Seven consecutive cases of Brucella mellitensis endocarditis were treated over the last 20 years, based on high suspicion of the disease at first place. The early suspicion of Brucella endocarditis relied on medical history and a standard tube agglutination titer > or =20. Blood and/or cardiac tissue cultures were positive in all patients, but available late following surgery. All patients were successfully treated with a combination of aggressive medical and early surgical therapy. All affected valves were replaced within 1 week from admission (five aortic and three mitrals). Medical treatment included co-trimoxazole, tetracyclines and streptomycin, before surgery, followed by co-trimoxazole and tetracyclines for a median of 12 months (range: 3-15 months) after surgery until the titers returned to a level < or =1:160. RESULTS There were neither operative deaths nor recurrence of infection. One patient died two years after the operation due to massive cerebrovascular accident. Ten-year survival was 85.7+/-13.2%. CONCLUSION Although Brucella mellitensis endocarditis is a rare entity, its optimum management should be a combination of aggressive medical treatment and early surgical intervention, based on high degree of suspicion in areas with high incidence of the disease.
Collapse
Affiliation(s)
- L Hadjinikolaou
- Departments of Cardiology and Cardiothoracic Surgery, University of Thessaly, Larissa, Greece.
| | | | | | | | | |
Collapse
|
14
|
Keleş C, Bozbuğa N, Sişmanoğlu M, Güler M, Erdoğan HB, Akinci E, Yakut C. Surgical treatment of Brucella endocarditis. Ann Thorac Surg 2001; 71:1160-3. [PMID: 11308153 DOI: 10.1016/s0003-4975(00)02663-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Brucella endocarditis (BE) is a lethal complication of human brucellosis, which is rarely seen and hardly described. METHODS In the present report, six successfully treated cases of BE involving three native aortic valves, two native mitral-aortic valves, and a mitral bioprosthesis are described. The diagnosis of BE was based on clinical features, high brucella serologic titers, and positive blood cultures. Although the blood cultures were positive in all patients, all the resected valve materials and tissue cultures were negative. The patients received rifampicin, streptomycin, and doxycycline (in 3 patients), rifampicin, tetracycline, and cotrimoxazole (in 2 patients), and rifampicin, doxycycline, and cotrimoxazole (in 1 patient). Infected native valves and bioprosthesis were replaced by mechanical valves. RESULTS There was no early or late mortality. No recurrent infection developed after management with a combination of antibiotherapy lasting 6 months postoperatively during a mean follow-up of 47 months (range 20 to 84 months). CONCLUSIONS This report suggests that the combination of valve replacement and antibiotic therapy produces successful results in the treatment of BE.
Collapse
Affiliation(s)
- C Keleş
- Koşuyolu Heart and Research Hospital, Istanbul, Turkey
| | | | | | | | | | | | | |
Collapse
|
15
|
Abstract
The etiologic diagnosis of infective endocarditis is easily made in the presence of continuous bacteremia with gram-positive cocci. However, the blood culture may contain a bacterium rarely associated with endocarditis, such as Lactobacillus spp., Klebsiella spp., or nontoxigenic Corynebacterium, Salmonella, Gemella, Campylobacter, Aeromonas, Yersinia, Nocardia, Pasteurella, Listeria, or Erysipelothrix spp., that requires further investigation to establish the relationship with endocarditis, or the blood culture may be uninformative despite a supportive clinical evaluation. In the latter case, the etiologic agents are either fastidious extracellular or intracellular bacteria. Fastidious extracellular bacteria such as Abiotrophia, HACEK group bacteria, Clostridium, Brucella, Legionella, Mycobacterium, and Bartonella spp. need supplemented media, prolonged incubation time, and special culture conditions. Intracellular bacteria such as Coxiella burnetii cannot be isolated routinely. The two most prevalent etiologic agents of culture-negative endocarditis are C. burnetti and Bartonella spp. Their diagnosis is usually carried out serologically. A systemic pathologic examination of excised heart valves including periodic acid-Schiff (PAS) staining and molecular methods has allowed the identification of Whipple's bacillus endocarditis. Pathologic examination of the valve using special staining, such as Warthin-Starry, Gimenez, and PAS, and broad-spectrum PCR should be performed systematically when no etiologic diagnosis is evident through routine laboratory evaluation.
Collapse
Affiliation(s)
- P Brouqui
- Unité des Rickettsies, CNRS UPRESA 6020, Faculté de Médecine, 13385 Marseille Cedex 5, France.
| | | |
Collapse
|
16
|
Kaya B, Sirlak M, Özkan M, Eryilmaz S, Akalin H. Brucella Endocarditis Treated by Surgical and Medical Combination. Asian Cardiovasc Thorac Ann 2000. [DOI: 10.1177/021849230000800319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A 40-year-old man developed brucella endocarditis. Brucella melitensis was isolated from blood cultures. Echocardiography revealed flail mitral valve with ruptured chordae. Mitral valve replacement was performed and the infection was cured with tetracycline and rifampin given for 3 months after surgery.
Collapse
Affiliation(s)
- Bülent Kaya
- Department of Cardiovascular Surgery University of Ankara Medical School Ankara, Turkey
| | - Mustafa Sirlak
- Department of Cardiovascular Surgery University of Ankara Medical School Ankara, Turkey
| | - Mehmet Özkan
- Department of Cardiovascular Surgery University of Ankara Medical School Ankara, Turkey
| | - Sadik Eryilmaz
- Department of Cardiovascular Surgery University of Ankara Medical School Ankara, Turkey
| | - Hakki Akalin
- Department of Cardiovascular Surgery University of Ankara Medical School Ankara, Turkey
| |
Collapse
|
17
|
Affiliation(s)
- O S Diaz
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania, School of Veterinary Medicine, Kennett Square 19348, USA
| | | | | | | |
Collapse
|
18
|
Abstract
Brucella endocarditis is a lifethreatening, often under-diagnosed complication of brucellosis. Seven cases of brucella endocarditis treated surgically in the last 25 years are described. The infection was localized on the aortic valve in 5 cases and on a prosthetic mitral valve in 2. All patients had a positive history of risk factors for brucella infection and all were in cardiac failure (5 in New York Heart Association functional class III and 2 in class IV). All underwent valve replacement followed by antibiotic therapy. Follow-up ranged from 1 and 206 months. One patient died following prosthetic valve replacement to treat a periprosthetic leak unrelated to the brucella infection. Brucella antibody tests and careful clinical history are mandatory in all patients with negative blood cultures in order to identify brucella earlier during the course of the infection before embolization or annular involvement occur.
Collapse
|
19
|
Abstract
A case of chronic brucella endocarditis of a prosthetic valve is reported. The diagnosis of this infection was established by positive blood cultures and high brucella agglutination titre. The patient was successfully managed by combination of medical therapy (consisting of streptomycin, trimethoprim-sulphamethoxazole, rifampin and tetracycline) and surgery.
Collapse
Affiliation(s)
- H Arslan
- Başkent University School of Medicine, Internal Medicine Department, Ankara, Turkey
| | | | | | | |
Collapse
|
20
|
Berbari EF, Cockerill FR, Steckelberg JM. Infective endocarditis due to unusual or fastidious microorganisms. Mayo Clin Proc 1997; 72:532-42. [PMID: 9179137 DOI: 10.4065/72.6.532] [Citation(s) in RCA: 180] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Infective endocarditis due to fastidious microorganisms is commonly encountered in clinical practice. Some organisms such as fungi account for up to 15% of cases of prosthetic valve infective endocarditis, whereas organisms of the HACEK group (Haemophilus parainfluenzae, H. aphrophilus, and H. paraphrophilus, Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella kingae) cause 3% of community-acquired cases of infective endocarditis. Special techniques are necessary to identify these microorganisms. A history of contact with mammals or birds may suggest infection caused by Coxiella burnetii (Q fever), Brucella species, or Chlamydia psittaci. A nosocomial cluster of postsurgical infective endocarditis may be caused by Legionella species or Mycobacterium species. If risk factors that are commonly associated with fungal infections (cardiac surgical treatment, prolonged hospitalization, indwelling central venous catheters, and long-term antibiotic use) are present, fungal endocarditis is possible. Patients with endocarditis and a history of periodontal disease or dental work in whom routine blood cultures are negative might have infection due to nutritionally variant streptococci or bacteria of the HACEK group. Communication between the microbiologist and the clinician is of crucial importance for identification of these microorganisms early during the course of the infection before complications such as embolization or valvular failure occur. In this article, we review the microbiologic and clinical features of these organisms and provide recommendations for diagnosis and treatment.
Collapse
Affiliation(s)
- E F Berbari
- Division of Infectious Diseases and Internal Medicine, Mayo Clinic Rochester, Minnesota 55905, USA
| | | | | |
Collapse
|
21
|
|