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Query: UMLS:C0014118 (endocarditis)
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Endocarditis is a rare complication of brucellosis, often fatal, and the treatment is controversial. We present a case of Brucella melitensis endocarditis successfully treated by a combination of surgical resection and antibiotics.
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PMID:A case of Brucella melitensis endocarditis successfully treated by a combination of surgical resection and antibiotics. 868 49

Brucella infective endocarditis is an uncommon, but serious complication of brucellosis. The aortic valve is the most commonly affected cardiac valve, and a fearful complication is the formation of aortic root abscess. Due to the characteristics of the infection, medical therapy alone is not sufficient in treating the disease and best results are achieved in combination with surgery. We describe 2 cases of brucella endocarditis involving the aortic valve. Aggressive treatment, with surgery performed during a period of active infection, produced good results in eradication of infection and in preventing fatal complications such as rupture of aortic root abscesses.
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PMID:[Brucella endocarditis: role of drug treatment associated with surgery]. 876 36

We conducted a prospective, noncomparative, multicenter study to assess the safety and efficacy of doxycycline and netilmicin in the treatment of human brucellosis. The study included 64 patients who had acute brucellosis without endocarditis or neurobrucellosis. The treatment schedule consisted of the administration of 100 mg of doxycycline (or 5 mg/[kg.d] if body weight < or = 40 kg) twice a day orally for 45 days, plus 300 mg of netilmicin (6 mg/[kg.d] if body weight < or = 50 kg) intramuscularly once daily for 7 days. Therapeutic failure was noted in 5 patients (7.7%; 95% confidence interval [CI], 2.5%-17.1%), of whom 2 had spondylitis, 1 had sacroiliitis, and 1 had a splenic abscess that required splenectomy. Relapse was noted in eight patients (12.5%; 95% CI, 5.6%-23.2%). When relapse was considered in combination with initial lack of efficacy, 13 patients (21.9%; 95% CI, 12.3%-33.9%) failed to respond to therapy. Fifteen patients (23%; 95% CI, 13.5%-35.2%) had adverse effects, and one patient (1.5%) had a treatment-limiting adverse effect. Combination therapy with netilmicin/doxycycline may be effective in treating acute brucellosis. However, prospective controlled trials must confirm these results.
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PMID:Treatment of human brucellosis with netilmicin and doxycycline. 885 60

Brucellosis (infection with Brucella spp.) is a common zoonosis in many parts of the world. Human brucellosis is a multisystem disease that may present with a broad spectrum of clinical manifestations. Treatment of brucellosis must effectively control acute illness and prevent complications and relapse. The choice of regimen and duration of antimicrobial therapy should be based on the presence of focal disease and underlying conditions which contraindicate certain specific antibiotics. The regimen of first choice is combination therapy with doxycycline for 45 days and streptomycin for 14 days. Gentamicin or netilmicin for the first 7 days may be substituted for streptomycin. Second-choice regimens consist of combinations of doxycycline and rifampicin (rifampin) for 45 days, or monotherapy with doxycycline for 45 days. Surgery should be considered for patients with endocarditis, cerebral or epidural abscess, spleen abscess or other abscesses which are antibiotic-resistant. Tetracyclines are generally contraindicated for pregnant patients and children < 8 years old. Rifampicin 900 mg once daily for 6 weeks is considered the drug of choice for treating brucellosis in pregnant women. In children < 8 years old the preferred regimen is rifampicin with cotrimoxazole (trimethoprim-sulfamethoxazole) for 45 days. An alternative regimen consists of a combination of rifampicin for 45 days with gentamicin 5 to 6 mg/kg/day for the first 5 days.
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PMID:Recognition and optimum treatment of brucellosis. 902 44

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.
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PMID:Conservative treatment for Brucella endocarditis. 906 18

Brucellosis, which decreased during the eighties in France, remains a public health problem in many Mediterranean countries. We report the case of a 65-year old patient native of Morocco, of thoracic aorta aneurysm and lumbar spondylodiscitis due to Brucella melitensis, revealed by haemoptysis and lumbar pains, with a favourable outcome after aortic graft resection, spinal plaster immobilization and specific lengthy antibiotic treatment. This case report is characterized by the absence of endocarditis or infectious focus near the aneurysm. Diagnosis of aneurysm and spondilitis due to Brucella melitensis is based on imaging and bacteriological and serological examination. Because of a clinical and biological intolerance for rifampicin and cotrimoxazole, this patient received ofloxacin-doxycyclin-streptomycin. We discuss antibiotic recommendations and stress the interest of the early diagnosis of complicated forms of brucellosis for a better prognosis.
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PMID:[Aneurysm of the thoracic aorta and spondylodiscitis disclosing brucellosis]. 949 88

All series of infective endocarditis had a variable proportion of cases without an etiologic agent because all cultures were negative. New microbiologic techniques have permitted the discovery of the role of many microorganisms in infective endocarditis. C. burnetii is an increasing causative agent of subacute infective endocarditis. In the diagnosis, to the detection of antiphase-I antibodies, immunohistochemical, molecular techniques and cellular cultures have been added. Total cure is difficult to obtain. The combination of doxicicline plus ciprofloxacin for at least 3 years has been proposed as the treatment of choice. Surgery must be reserved for patients with cardiac insufficiency. Less than 2% of cases of acute brucellosis are complicate with infective endocarditis. Infective endocarditis produces serious and rapid valvular destruction with high mortality rates if valve surgery is not performed. For medical treatment at least 3 active agents are required. Bartonella has recently been described as an etiologic agent of infective endocarditis. It mainly affects to homeless people living in poor hygienic conditions. The aortic valve is most commonly involved and, frequently, valve insufficiency requires valve replacement. Blood culture isolation needs long incubation periods. Parenteral nutrition, immunosuppression, wide spectrum antibiotic regimens, intravenous drug addiction and cardiovascular surgery are risk factors previously described in the development of fungal endocarditis. C. albicans and Aspergillus spp. are most frequent etiologic agents. Infective endocarditis should be suspected in any patient with systemic fungal disease. Blood cultures are often negative except for Candida spp. Peripheral emboli and large vegetations are frequent. Mortality is high, antifungal therapy combined with surgery is the treatment of choice. Legionella, Mycoplasma, Chlamydia, Mycobacteria, viruses are potential agents of infective endocarditis, and difficult to diagnose because of special culture requirements. Epidemiological clues, serologic and molecular techniques and blood cultures could identify them.
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PMID:[Infective endocarditis caused by unusual microorganisms]. 965 53

The species Bartonella and Brucella are phylogenetically closely related bacteria, both of which can produce chronic infections in humans that are difficult to cure with antibiotics. MICs of antibiotics for both species correlate poorly with the in vivo efficacy of the antibiotics. In this study we have determined MBCs of several antibiotics for this group of pathogens. Only the aminoglycosides were bactericidal, and this correlates well with the usefulness of these antibiotics for the therapy of human brucellosis and chronic Bartonella spp. infections such as endocarditis. Our data indicate that current clinical experience in treating brucellosis may help to define better the optimum antibiotic therapy for Bartonella-related diseases.
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PMID:Bactericidal effect of antibiotics on Bartonella and Brucella spp.: clinical implications. 1106 4

Human brucellosis is a multisystem disease that may present with a broad spectrum of clinical manifestations. The primary goals of therapy for brucellosis are to improve the symptoms, reduce complications and prevent relapses. The choice of a regimen and duration of antimicrobial therapy should be based on the location of the disease and the underlying conditions. The regimen of choice is a combination therapy with doxycycline for 45 days and streptomycin for 14 days. A second-choice consists of a combination of doxycycline and rifampin for 45 days. Children under 8 years old and pregnant women should not be treated with tetracyclines. In children under 8 years old, the preferred regimen is rifampin with cotrimoxazole or gentamicin. Rifampin (900 mg once daily for 6 weeks) is considered the drug of choice for treating brucellosis in pregnant women. Surgery should be considered for patients with endocarditis, cerebral, epidural or splenic abscess or other abscesses, which are resistant to antibiotics.
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PMID:Treatment of human brucellosis. 1121 98

Endocarditis is a rare but serious complication of brucellosis. We report here a case of Brucella abortus endocarditis occurring on a prosthetic mitral valve. The diagnosis was established by positive serology, the presence of vegetation on the mitral prosthesis and isolation of B. abortus from the blood and valve cultures. The patient was successfully treated with combined medical and surgical therapy.
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PMID:A case of prosthetic mitral valve endocarditis caused by Brucella abortus. 1123 84


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