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      A Case of Brucella Endocarditis in Association with Subclavian Artery Thrombosis

      case-report

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          Abstract

          Brucellosis is a common zoonosis, endemic in Mediterranean countries, and caused by bacteria of Brucella genus. Brucellosis is a systemic infection and the clinical presentation varies widely from asymptomatic and mild to severe disease. Cardiovascular complications are extremely rare. We present a case of arterial thrombosis in a previously healthy young patient with Brucella endocarditis. Careful attention must be paid to any sign or symptom of thrombosis in patients affected by brucellosis, regardless of the presence of endocarditis and cardiovascular risk factors.

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          Clinical manifestations and complications in 1028 cases of brucellosis: a retrospective evaluation and review of the literature.

          Turan Buzgan, Mustafa Kasım Karahocagil, Hasan Irmak … (2010)
          Brucellosis is the most prevalent bacterial zoonosis worldwide. In this study, we aimed to compare our 1028 brucellosis cases with other big series in the literature in view of epidemiological, clinical, and laboratory findings and therapeutic features. A total of 1028 brucellosis cases admitted to the Department of Infectious Diseases and Clinical Microbiology over a 10-year period were included in the study. A retrospective analysis was undertaken and patient files were reviewed for history, clinical and laboratory findings, and therapeutic features, as well as complications. Of the 1028 patients, 539 (52.4%) were female and 489 (47.6%) were male. The mean age of patients was 33.7+/-16.34 years and 69.6% of cases were aged 13-44 years. Four hundred and thirty-five cases (42.3%) had a history of raising livestock and 55.2% of the cases were found to have no occupational risk for brucellosis. Six hundred and fifty-four of the cases (63.6%) had a history of raw milk and dairy products consumption. The most frequently seen symptoms were arthralgia (73.7%) and fever (72.2%), while the most common clinical findings were fever (28.8%) and hepatomegaly (20.6%). The most frequent laboratory finding was a high C-reactive protein level (58.4%). The standard tube agglutination (STA) test+Coombs STA test was positive in 1016 cases (98.8%). Focal involvement was present in 371 (36.1%) cases. The most frequent involvement was osteoarticular involvement with 260 cases (25.3%). The overall relapse rate for patients with brucellosis was 4.7%. The highest relapse rate, 8.5%, was observed in the group of patients with osteoarticular involvement. Regimens including doxycycline and streptomycin with or without rifampin appeared more effective than other regimens in osteoarticular involvement. In humans, brucellosis may lead to serious morbidity, and it continues to be a major health problem in Turkey. There is no recommended treatment protocol for complicated brucellosis. Large multicenter studies are needed to determine the most appropriate treatment choices and durations in complicated brucellosis. Copyright 2009 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
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            Proinflammatory response of human endothelial cells to Brucella infection.

            M Delpino, Paula Barrionuevo, Julieta Bregante … (2011)
            Although vascular pathologies such as vasculitis, endocarditis and mycotic aneurysms have been described in brucellosis patients, the interaction of Brucella with the endothelium has not been characterized. In this study we show that Brucella abortus and Brucella suis can infect and replicate in primary human umbilical vein endothelial cells (HUVEC) and in the microvascular endothelial cell line HMEC-1. Infection led to an increased production of IL-8, MCP-1 and IL-6 in HUVEC and HMEC-1 cells, and an increased expression of adhesion molecules (CD54 in both cells, CD106 and CD62E in HUVEC). Experiments with purified antigens from the bacterial outer membrane revealed that lipoproteins (Omp19) but not lipopolysaccharide mediate these proinflammatory responses. Infection of polarized HMEC-1 cells resulted in an increased capacity of these cells to promote the transmigration of neutrophils from the apical to the basolateral side of the monolayer, and the same phenomenon was observed when the cells were stimulated with live bacteria from the basolateral side. Overall, these results suggest that Brucella spp. can infect and survive within endothelial cells, and can induce a proinflammatory response that might be involved in the vascular manifestations of brucellosis. Copyright © 2011 Institut Pasteur. Published by Elsevier Masson SAS. All rights reserved.
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              Brucella endocarditis: clinical, diagnostic, and therapeutic approach.

              Claudio Juarez, J Pachón, J Reguera … (2003)
              Brucella endocarditis is an uncommon focal complication of brucellosis. Presented here are 11 cases of Brucella endocarditis, all managed uniformly. The median duration of symptoms prior to diagnosis was 3 months. Five patients (45%) had underlying valvular damage, and in six (55%) endocarditis involved a normal valve. There was a predominance of aortic involvement (82%) and a high incidence of left ventricular failure (91%). Diagnostic suspicion was essential in order to test blood cultures correctly, which in this series were positive in 63% of the patients. Surgical treatment was undertaken in eight patients (72%), all with aortic involvement and left ventricular failure impossible to control with medication. One patient died during the immediate postoperative period. All the other patients received antibiotic therapy for 3 months, with no signs of relapse of the infection or malfunction of the prosthesis during a minimum follow-up period of 24 months.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Case Rep Infect Dis
                Journal ID (iso-abbrev): Case Rep Infect Dis
                Journal ID (publisher-id): CRIM.ID
                Title: Case Reports in Infectious Diseases
                Publisher: Hindawi Publishing Corporation
                ISSN (Print): 2090-6625
                ISSN (Electronic): 2090-6633
                Publication date (Print): 2012
                Publication date (Electronic): 10 July 2012
                Volume: 2012
                Electronic Location Identifier: 581489
                Affiliations
                Dipartimento di Scienze della Promozione della Salute G. D'Alessandro, Sezione di Malattie Infettive, Università di Palermo, 90127 Palermo, Italy
                Author notes

                Academic Editors: X. Vallès and W. I. van der Meijden

                Article
                DOI: 10.1155/2012/581489
                PMC ID: 3400327
                PubMed ID: 22844622
                SO-VID: 3e6940e8-14c5-47b6-b85d-d11b0ff43da8
                Copyright © Copyright © 2012 Claudia Colomba et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 26 March 2012
                Date accepted : 21 June 2012
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Infectious disease & Microbiology
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology

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