Endocarditis de la válvula aórtica causada por Brucella melitensis / Aortic valve endocarditis caused by Brucella melitensis

La endocarditis bacteriana secundaria a la infección por Brucella spp., en este caso B. melitensis, como complicación de la brucelosis humana tiene una incidencia baja y, aunque es la presentación clínica con la que se asocia más frecuentemente la mortalidad, no todos los casos son letales, si son tratados oportunamente. Se describe el caso clínico de una endocarditis bacteriana por B. melitensis, diagnosticada en un adulto por el aislamiento del microorganismo en el hemocultivo. Paciente del sexo masculino, de 40 años, con antecedentes de realizar partos en el ganado bovino y consumir leche no pasteurizada. Acudió al médico por presentar durante siete días de evolución de las siguientes manifestaciones clínicas: fiebre, mialgias, artralgias, tos seca y pérdida de peso (15 kg). El hemograma informa: leucopenia, trombocitopenia y anemia; mientras que en un ecocardiograma transesofágico se observó vegetación en la válvula aórtica con una disminución de la función sistólica y en el hemocultivo se aisló B. melitensis. Debido a estos antecedentes, se inició el tratamiento antibacteriano con rifampicina, doxiciclina y gentamicina. El paciente se recuperó y tuvo una evolución clínica satisfactoria. La brucelosis es una enfermedad infrecuente. Debe considerarse en toda persona con fiebre de foco desconocido que resida en zonas endémicas o esté expuesto al cuidado de animales de granja. En esta enfermedad se impone un diagnóstico y tratamiento preciso, por ser una complicación con alta letalidad.

Bacterial endocarditis, secondary to Brucella spp. infection, in this case by B. melitensis, as a complication of human brucellosis has a low incidence. Although it is the clinical presentation most frequently associated with mortality, not all cases are lethal if timely treatment is provided. We describe a clinical case of bacterial endocarditis due to B. melitensis in a 40-year-old male patient with a history of conducting cattle deliveries and consuming unpasteurized milk, diagnosed after isolating the microorganism in blood culture. He presented with the following clinical manifestations after seven days of evolution: fever, myalgias, arthralgias, dry cough and weight loss (15 kg). The hemogram revealed leukopenia, thrombocytopenia, and anemia; while a transesophageal echocardiogram showed vegetation on the aortic valve with decreased systolic function, and B. melitensis was isolated in a blood culture. Considering this medical history, antibacterial treatment was initiated with rifampicin, doxycycline and gentamicin. The patient recovered and had satisfactory clinical evolution. Brucellosis is a rare disease. It should be considered in any person with a fever of unknown origin who lives in endemic areas or is exposed to the care of farm animals. Endocarditis is a highly lethal complication of human brucellosis; therefore, it requires a precise diagnosis and treatment.

Human brucellosis in Khartoum state: a commonly underdiagnosed disease

Human brucellosis is a major debilitating zoonotic disease. It is caused by bacteria of the genus Brucella The serum antibody titres to Brucella melitensis and Brucella abortus of one thousand febrile patients, randomly selected from Khartoum, Khartoum North and Omdurman Teaching Hospitals, were estimated by the STAT. Eighty nine [8.9%] of the febrile patients had brucellosis. The average age of brucellosis patient was 43.9 years. Sixty three [70.8%] of the brucellosis patients were males, and 26 [29.2%] were females. Fifty four [60.7%] of them had significant titres to Brucella melitensis while 23 [25.8%] patients had significant titres to Brucella abortus. Twelve [13.5%] patients had significant titres to both Brucella melitensis and Brucella abortus. The average diagnostic delay of brucellosis in this study was 88.6 days. Brucellosis was found to be misdiagnosed as malaria or typhoid fever. Animal contact was found to be a significant risk factor

Combined Brucella Melitensis and Streptococcal Viridans Endocarditis

Infectious endocarditis is a potentially lethal inflammation of the hearts' inner lining invaded by microorganisms. The mortality from this illness increases as the number of infective organisms rises to 2, due to involvement of the left side of the heart. These microorganisms usually arise from the patient's own flora but can be acquired from the environment. Fever and heart murmurs are the principal clinical manifestations followed by a plethora of peripheral signs due to dissemination of microorganisms via the bloodstream. Echocardiographic imaging and sensitive culture techniques form the cornerstone of diagnosis. We report a patient with rheumatic heart disease who had combined brucella melitensis and streptococcus viridans endocarditis complicated by heart failure and an aortic root abscess. He was diagnosed on the basis of a history of prolonged fever and occupational risk as a shepherd, the presence of heart murmurs, positive blood cultures and echocardiographic evidence of aortic vegetations. He had an excellent response to intravenous antibiotic therapy combined with aortic valve replacement, which nowadays is regarded as the safest therapeutic approach for aortic valve endocarditis

Brucelosis humana en América / Human brucellosis in America

Brucellosis ís a worldwide emerging zoonosis, Mexico, Peru and Rio de La Plata basin are most endemic areas ín America. Although Babortus - affecting cattie - is most spread in animals all around the world, 8. melitensis causes most of human cases. Its clinical features are classic with varied manifestations that may compromiso severas body systems, fever, specially an ondulating pattem, and arthralgia or lumbalgia suggest the diagnosis. Fever and matase are present in 96.8 and 84.2 percent of cases; headache, anorexia, chills and arthralgia are common symptoms too. Diagnosis is based on clinical presentaron, serology and specially blood or bone marrow cultures. Combined doxicycline and rífampin is the first choice treatment

Brucella melitensis endocarditis: diagnosis and treatment in six adult patients

Brucella endocarditis is an uncommon but not rare manifestation of brucellosis in our country. We report six adult patients aged 20 to 45 years. Two of our patients were female, and this is the first time that Brucella endocarditis was reported in adult females. In five cases, aortic valve replacement was performed in addition to combined antibiotic therapy. One of them died due to immediate complication of cardiac surgery, but the others had an excellent recovery. Our study shows that medical treatment is not sufficient for Brucella mellitensis endocarditis, and urgent cardiac valve replacement must be considered. The prognosis will not be poor with combined medical and surgical therapy

Brucellosis epidemiology, clinical and therapeutic

A retrospective survey, over a 18 years period [1971-1989] at the Infectious Diseases Unit- La Rabta, yielded 47 cases of brucellosis. Brucellosis is common in men, after a professional exposure [27%] or consummation of milk and by-products non fermented [36%]. The clinical picture of the disease was a fever of less than 3 weeks duration [71%] associated to sweat and pain. Focalised forms are seldom and there were no chronic form. Brucella melitensis was isolated from blood in 23%. The efficacy of antibitherapy [cyclin associated to rifampicin] was excellent. The prognosis was good with recovery in all cases even in one case of relapse under cyclin