PMID- 9738123
OWN - NLM
STAT- MEDLINE
DCOM- 19981014
LR  - 20161124
IS  - 1341-1098 (Print)
IS  - 1341-1098 (Linking)
VI  - 4
IP  - 4
DP  - 1998 Aug
TI  - The role of aggressive medical therapy along with early surgical intervention in 
      the cure of Brucella endocarditis.
PG  - 209-13
AB  - Timing of surgical intervention in Brucella endocarditis remains controversial. 
      In this report, we review our experience in an attempt to collect some 
      information on the best approach for this entity. From June 1992 to December 
      1996, 5 male patients between the ages of 20 and 35 years with Brucella 
      endocarditis were operated on in our centre. Three of them had native valve 
      endocarditis (NVE) and 2 with prosthetic valve endocarditis (PVE). All patients 
      belonged to New York Heart Association (NYHA) class III-IV. All had developed 
      anti Brucella antibodies with serum agglutination titres of > 320 and the sera 
      tested from 3 patients were Enzyme Linked Immunosorbent Assay (ELISA) positive 
      for anti-Brucella IgM and/or IgG antibodies. In 3 cases 2D-echocardiography 
      showed large vegetation on the affected valve. Blood cultures were positive in 4 
      patients, 2 of them (one each of NVE and PVE) had the valve material culture 
      positive for Brucella. All cases were treated with a combination of doxycycline, 
      refampicine and gentamicin before surgery. Major indication for surgical 
      intervention was severe haemodynamic instability which developed during the 
      course of antibiotic therapy either early (3 cases) or late (2 cases). All 
      patients became asymptomatic at the end of 7 days postoperatively. On the 
      follow-up for a period of 8-51 months, all patients were in NYHA class I-II 
      without evidence of recurrence of infection. These data suggest that in either 
      NVE or PVE Brucella, medical therapy alone may not be sufficient due to the 
      eventual haemodynamic deterioration secondary to valve tissue destruction or 
      dysfunction of the prosthetic valve caused by the infective process. Therefore, a 
      combination of aggressive medical therapy with multiple bactericidal antibiotics 
      and early surgical intervention may result in a successful outcome, but further 
      studies are needed to reach a reliable conclusion.
FAU - Uddin, M J
AU  - Uddin MJ
AD  - Department of Cardiac Surgery, Chest Diseases Hospital, Ibn Sina Hospital, P.O. 
      Box 4082, Safat-13041, Kuwait.
FAU - Sanyal, S C
AU  - Sanyal SC
FAU - Mustafa, A S
AU  - Mustafa AS
FAU - Mokaddas, E M
AU  - Mokaddas EM
FAU - Salama, A L
AU  - Salama AL
FAU - Cherian, G
AU  - Cherian G
FAU - Mounjaeed, M
AU  - Mounjaeed M
FAU - Shuhaiber, H
AU  - Shuhaiber H
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - Japan
TA  - Ann Thorac Cardiovasc Surg
JT  - Annals of thoracic and cardiovascular surgery : official journal of the 
      Association of Thoracic and Cardiovascular Surgeons of Asia
JID - 9703158
RN  - 0 (Anti-Bacterial Agents)
RN  - 0 (Antibodies, Bacterial)
SB  - IM
MH  - Adult
MH  - *Anti-Bacterial Agents
MH  - Antibodies, Bacterial/analysis
MH  - Brucella/immunology/isolation & purification
MH  - Brucellosis/microbiology/*therapy
MH  - *Cardiovascular Surgical Procedures
MH  - Combined Modality Therapy
MH  - Drug Therapy, Combination/*therapeutic use
MH  - Echocardiography
MH  - Endocarditis, Bacterial/diagnostic imaging/*therapy
MH  - Enzyme-Linked Immunosorbent Assay
MH  - Follow-Up Studies
MH  - Heart Valve Diseases/diagnostic imaging/microbiology/*therapy
MH  - Heart Valve Prosthesis Implantation
MH  - Humans
MH  - Male
MH  - Prosthesis-Related Infections/diagnostic imaging/*therapy
MH  - Retrospective Studies
MH  - Treatment Outcome
EDAT- 1998/09/17 00:00
MHDA- 1998/09/17 00:01
CRDT- 1998/09/17 00:00
PHST- 1998/09/17 00:00 [pubmed]
PHST- 1998/09/17 00:01 [medline]
PHST- 1998/09/17 00:00 [entrez]
PST - ppublish
SO  - Ann Thorac Cardiovasc Surg. 1998 Aug;4(4):209-13.