Brucella Endocarditis of the Native Mitral Valve Treated With Antibiotics.

Muhammad A Raza,Komal Ejaz,Daniel Kazmierski

doi:10.7759/cureus.8167

Abstract

Brucellosis is a rare zoonotic infection with a low annual incidence in the United States. Infective endocarditis secondary to brucellosis involving native or prosthetic valves is contemplated to be an extremely rare entity. As Brucella can present with non-specific sign and symptoms, clinicians need to have a higher degree of suspicion of Brucella endocarditis in culture-negative endocarditis patients, particularly those who have a history of exposure to farm animals. Timely diagnosis with appropriate management using antibiotics can prevent valvular damage and restore the valve's structural integrity. In this case report, we present a case of culture-negative, serology-proven Brucella endocarditis of native mitral valve, with an initial presentation of stroke that was successfully treated with combination antibiotic therapy.

Highlights

Brucellosis is a worldwide zoonotic infection caused by a gram-negative intracellular bacillus of the genus Brucella
The patient underwent a transesophageal echocardiography (TEE), which revealed that his mitral valve (MV) was myxomatous and redundant, with mild prolapse and a large mass with associated hypermobile elements attached under the anterior leaflet apparatus and extending to the insertion of the anterior leaflet
Brucellosis is endemic in developing regions such as the Mediterranean, Middle East, South Asia and South America, it is rare in the developed world with an annual worldwide incidence of approximately 500,000 cases as compared to barely 100 to 200 cases of human brucellosis reported annually in the United States (US) [1,4]

Summary

Introduction

Brucellosis is a worldwide zoonotic infection caused by a gram-negative intracellular bacillus of the genus Brucella. Human brucellosis is mainly transmitted via cheese and unpasteurized animal milk It frequently presents with non-specific symptoms such as fever and malaise, but can lead to multiorgan failure. A 50-year-old male with a past medical history significant for hepatitis C and intravenous drug abuse with recent incarceration presented to the emergency department (ED) with right-sided weakness and aphasia. The patient underwent a transesophageal echocardiography (TEE), which revealed that his mitral valve (MV) was myxomatous and redundant, with mild prolapse and a large mass with associated hypermobile elements attached under the anterior leaflet apparatus and extending to the insertion of the anterior leaflet. The initial workup of infective endocarditis (IE) including methicillin-resistant Staphylococcus aureus (MRSA), blood cultures and HIV test was negative, and the patient was treated empirically for culture-negative IE with vancomycin and cefepime. The patient’s clinical improvement was deemed satisfactory, and he was asked to follow up in two months upon completion of his antibiotics course

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Disclosures

Wise RI