Involvement In Brucellosis Research Articles

The research trend on neurobrucellosis over the past 30 years (1993-2023): a bibliometric and visualization analysis.

Brucellosis is a zoonotic disease caused by Brucella infection, which is common in pastoral areas. Neurological involvement in brucellosis is relatively rare. But since 1993, continuous studies have been reporting neurological complications of brucellosis, collectively referred to as neurobrucellosis. A bibliometric analysis of existing literature outlines current research progress and gaps and provides guidance for the clinical treatment of neurobrucellosis, promoting patient health in the process of guiding clinical practice, and improving their quality of life. CiteSpace and VOSviewer are software tools to visualize research trends and networks. By selecting specific areas of interest and configuring the right parameters, the tools can visualize past research data. The study retrieved the literature from the Web of Science Core Collection Database and downloaded it in plain text file format. Citespace6.1.6, VOSviewer v1.6.20, and Microsoft Excel 16.59 were used for analyzing the following terms: countries, institutions, authors' cooperation, journals, keywords, and co-citation. There are eight key results. (1) The publication volume shows a general upward trend. (2) Turkey is the country with the highest publication volume and contributing institutions. (3) Giambartolomei GH, Gul HC, and Namiduru M are the authors with the highest number of publications. (4) Neurology is the journal that published the highest number of related articles (n = 12). (5) "Diagnosis," "meningitis," and "features" are the top three frequently occurring keywords. (6) Keyword clusters show "antibiotic therapy" and "cerebrospinal fluid" have future study value. (7) The burst analysis of the keywords also indicates that "cerebrospinal fluid" may become a prominent keyword in future research. (8) The co-citation analysis concludes three categories of the cited articles, which are diagnosis, therapy, and complications, indicating the past research direction. This study highlights the complexity of neurobrucellosis, presenting the need for advanced diagnostic techniques and multifaceted treatment approaches. While antibiotics remain the cornerstone of therapy, the use of corticosteroids to mitigate inflammatory responses shows promise, albeit with concerns about potential sequelae and relapse. Future research should focus on refining therapeutic strategies that address both the direct effects of infection and the broader immunological impacts to improve patient outcomes and quality of life.

Association Between Diagnostic Delays and Spinal Involvement in Human Brucellosis: A Retrospective Case-Control Study.

Spinal involvement is a common but serious complication of human brucellosis. However, information on the risk factors associated with spinal involvement in individuals with brucellosis is limited. This retrospective case-control study aimed to determine the potential risk factors associated with spinal complications in inpatients with brucellosis. During the study period, brucellosis was diagnosed in 377 patients, of whom 108 (28.64%) showed spinal involvement. Those with spinal involvement were significantly older than patients in the control group (mean age [standard deviation], 53.25 [10.48] vs 43.12 [13.84] years, respectively; P < .001). The diagnostic delays were significantly longer in patients with spinal involvement than in the control group (mean delay [standard deviation], 11.17 [13.55] vs 6.03 [8.02] weeks; P = .001). Age >40 years (odds ratio, 5.42 [95% confidence interval, 2.65-11.05]; P < .001) and diagnostic delay >4 weeks (2.94 [1.62-5.35]; P < .001) were independently associated with spinal involvement in brucellosis. The lumbar spine at the L3-5 level was the most affected (152 of 249 [61.04%]). Back pain (92 of 108 in case patients vs 21 of 108 in controls; P < .001) and splenomegaly (23 vs 42 of 108, respectively; P = .005) differed significantly between the 2 groups. Age >40 years and diagnostic delay >4 weeks increased the risk of spinal involvement in brucellosis. Therefore, the time from symptom onset to diagnosis should be shortened, using effective measures to reduce spinal involvement risk.

Brucellosis involving the aorta and iliac arteries: a systematic review of 130 cases

Objective: Brucellosis, the most common bacterial zoonosis, poses a serious threat to public health in endemic regions. Cardiovascular complications of brucellosis, mostly pericarditis or endocarditis, are the leading cause of brucellosis-related death. Complications involving the aorta and iliac arteries are extremely rare but can be life-threatening. Our objective was to identify and review all reported cases of aortic and iliac involvement in brucellosis to provide a deep, up-to-date understanding of the clinical characteristics and management of the disease.Methods: Online searches in PubMed, Web of Science, China National Knowledge Infrastructure, and the Chinese Wanfang database were conducted to collect articles reporting cases of brucellosis with aortic and iliac artery involvement. All data in terms of patient demographics, diagnostic methods, clinical manifestations, and treatment regimens and outcomes were extracted and analyzed in this systematic review.Results: A total of 79 articles were identified, reporting a total of 130 cases of brucellosis with aortic and iliac artery involvement. Of the 130 cases, 110 (84.5%) were male individuals and 100 (76.9%) were over 50 years old. The patients had an overall mortality rate of 12.3%. The abdominal aorta was most commonly involved, followed by the ascending aorta, iliac artery, and descending thoracic aorta. Arteriosclerosis, hypertension, and smoking were the most common comorbidities. There were 71 patients (54.6%) who presented with systemic symptoms of infection at the time of admission. Endovascular therapy was performed in 56 patients (43.1%), with an overall mortality rate of 3.6%. Open surgery was performed in 52 patients (40.0%), with an overall mortality rate of 15.4%.Conclusion: Aortic and iliac involvement in brucellosis is extremely rare but can be life-threatening. Its occurrence appears to be associated with the male gender, an older age, arteriosclerosis, and smoking. Although the number of reported cases in developing countries has increased significantly in recent years, its incidence in these countries may still be underestimated. Early diagnosis and therapeutic intervention are critical in improving patient outcomes. Endovascular therapy has become a preferred surgical treatment in recent years, and yet, its long-term complications remain to be assessed.

Testicular involvement of Brucellosis: A 10-year, multicentre study.

The genito-urinary system is one of the most common areas of involvement in brucellosis. To present the epidemiological, clinical, and laboratory characteristics of patients with testicular involvement associated with brucellosis, together with the diagnostic and therapeutic approaches. Patients followed up for brucellosis-related testicular involvement between January 2012 and November 2022 were included in the study. Brucellosis is defined as the production of Brucella spp. in cultures, or clinical symptoms together with the serum standard tube agglutination test titer of ≥ 1/160. Inflammation in scrotal Doppler ultrasonography was based on testicular involvement. A retrospective evaluation was made of the data of 194 patients with brucellosis-related testicular involvement. The rate of determination of testicular involvement in brucellosis was 2.57%. The most affected patients were determined in the 16-30 years age range. On presentation, brucellosis was in the acute stage in 83.7% of patients. The most common symptoms on presentation were swelling and/or pain in the testes (86.6%). In the patients where a spermiogram could be performed, oligospermia was determined in 41.7%, and aspermia in 8.3%. When the testicular involvement of brucellosis was evaluated, epididymo-orchitis was present at the rate of 55.7%, epididymitis at 27.3%, and testis abscess at 5.1%. Although epididymo-orchitis was the most frequently determined form of involvement in this study, there was also seen to be a significant number of patients presenting with epididymitis. Male patients presented with the clinical status of brucellosis should be questioned about swelling and pain in the testes to avoid overlooking testicular involvement.

Brusellozda Kas İskelet Tutulumunda Manyetik Rezonans Görüntüleme ve İnflamatuar Belirteçlerin Tanıya Katkısı

Objective: Musculoskeletal involvement in brucellosis is very important. This study aimed to evaluate the magnetic resonance imaging (MRI) findings and hematological parameters as a predictive value for the diagnosis of musculoskeletal brucellosis. Methods: This prospective case-control study was conducted between June 2011 and November 2019 in a university hospital. Ninety-nine patients with the confirmed diagnosis of brucellosis without musculoskeletal involvement and forty-three brucellosis patients with musculoskeletal involvement were examined. The hematological, biochemical parameters, and radiological imaging findings of both groups were recorded. These parameters were statistically compared between the two groups. Results: The mean age of the patients (non-involvement group) and musculoskeletal involvement groups was 44.04 ± 23.11 and 37.92 ± 24.80 years, respectively (P = 0.062). C-reactive protein (CRP) and alkaline phosphatase (ALP) levels were significantly higher in the musculoskeletal involvement group (P &amp;lt; 0.05). The lower lymphocyte level was statistically significant in this group. Based on the receiver operating characteristic (ROC) analysis, the sensitivity and specificity were 70% and 65% for ALP, 77% and 58% for CRP, 83% and 45% for lymphopenia, respectively. There was no statistically significant difference between the two groups in terms of the other hematological and biochemical parameters. Spondylodiscitis (34.8%) was the most common MRI finding in patients with musculoskeletal involvement. Conclusions: Our study results show that CRP, ALP, and lymphopenia can be used as valuable markers in the preliminary diagnosis of musculoskeletal brucellosis.

Role of Surgery in Brucella Spondylodiscitis: An Evaluation of 28 Patients.

Background A limited number of studies are available in the literature on the surgical treatment of brucellosis-related spondylodiscitis. This study aimed to define and discuss the role of surgery in brucellosis-related spondylodiscitis. Methodology A total of 28 patients who underwent surgical treatment due to brucellosis-related spondylodiscitis between February 2021 and August 2022 were included in this study. Medical records, radiological images, and laboratory data were collected. Surgical results were evaluated according to the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels, clinical findings, postoperative radiological imaging findings, and complications were evaluated. Results In total, 16 of the patients included in the study were male and 12 were female, with a mean age of 56.4 ± 7.2 years. The mean follow-up duration was 11.8 ± 5.4 months. Brucellosis involvement was in the lumbosacral region in all patients. Overall, 21 patients had a neurological deficit in the preoperative period. Posterior stabilization and fusion were done in 20 (71.4%) patients, while simple laminectomy (decompression) and debridement were done in eight (28.6%) patients. There was a decrease in the pain in the lower back and leg in all patients in the postoperative period. Neurological recovery was achieved in 18 patients with a neurological deficit. Two patients underwent wound drainage in the postoperative period.The patient who had morbid obesity and comorbidities died in the postoperative period. ESR and CRP levels returned to normal at the end of the six-month follow-up. There was a significant recovery in VAS and ODI scores (p < 0.05). In total, 24 (85.4%) patients were considered fully recovered both radiologically and clinically at the end of the follow-up. Conclusions Although long-term and specific antibiotic treatment constitute the main treatment in brucellosis-related spondylodiscitis, debridement, decompression, and stabilization (when required) of infection with a focus on neurological deficits and instability formation and non-stop severe pain are effective and safe treatment options.

Spondylodiscitis as osteoarticular involvement in brucellosis

Spondylodiscitis as osteoarticular involvement in brucellosis

HEPATIC MANIFESTATIONS OF INFECTIOUS DISEASES. PRESENTATION OF CLINICAL CASE

There are infectious diseases that produce alterations in liver function tests and histology, through the activation, by endotoxins and other agents of the innate immunity pathway. This work aims to review the hepatic manifestations of diseases such as dengue and brucellosis in the pediatric age by means of clinical cases. Case 1: 17-year-old male with a history of travel to an endemic area and family members positive for dengue. Fever, myalgias, arthralgias, arthralgias and headache. On admission with leukocytes 6.93 thousand, platelets 189 thousand and positive IgG and IgM antibodies for dengue fever. Physical examination with hepatodynia and petechiae in the pelvic limbs. In control biochemistry with leukopenia and moderate thrombocytopenia, as well as alterations in liver function (Table 1). Ultrasound of the liver with data of acute inflammatory process. Seven days after admission, with clinical and biochemical improvement, it was decided the discharge of the patient. Caso 2: male, four years nine months old, with symptoms of 1 month of evolution characterized by fever, hyporexia and general malaise. Physical examination with icteric-pale color, hepatomegaly of 3 × 5 × 7 cm and splenomegaly of 4 cm. Paraclinical tests showed anemia, leukopenia and mild-moderate thrombocytopenia, hypertransaminasemia, cholestasis and TTP prolongation (Table 2) with positive rose bengal, hepatic USG with hepatomegaly and echogenicity changes, for which he was sent to the third level of care. The mechanisms of liver injury can be divided into four pathways: vascular, toxic, immune and hormonal. In infections, the immune pathway is the cause of liver damage, being activated by endotoxins, leading to inflammatory infiltration, the release of cytokines, reactive oxygen species and necrosis. In dengue infection, liver injury manifests with hypertransaminasemia, with a peak between the seventh and ninth day, progressive decrease and normalization between 2 to 8 weeks. Hepatic involvement in brucellosis can occur in the acute or chronic phase of the disease. In the acute phase, establishing a non-specific granulomatous hepatitis, increasing in 63% of the cases the liver function tests. The functions of the liver and the relationships it establishes with other organs may favor its injury during some infectious pathologies, being at this level one of the first manifestations in the context of an infectious disease, ruling out, in both cases, liver pathology by hepatotropic virus, metabolic, autoimmune and anatomical cause. The authors declare that there is no conflict of interest.

Clinicoepidemiological findings of childhood brucellosis in a tertiary care center in Central Anatolia: with the emphasis of hematological findings.

Human brucellosis is one of the most widespread zoonotic diseases that are presented with predominantly hematological manifestations. We aimed to evaluate the hematological findings of childhood brucellosis and to determine the predictive clinical findings and laboratory tests that might be related to hematologic involvement. We retrospectively analyzed the medical records of children with brucellosis between 1 January 2005 and 31 December 2018. We compared predictive clinical and physical examination findings and laboratory tests in patients with and without hematological involvement. A total of 212 patients (127 boys (59.9%)) with a mean age of 9.4±4.7 years were evaluated in this study. Blood cultures were performed in 161 (75.9%) patients and Brucella spp were isolated in 70 (43.4%) of them. Ninety-two (43.4%) patients had hematological involvement at least in one series. Anemia was detected in 66 (31.7%) patients, leukopenia in 22 (10.6%) and thrombocytopenia in 10 (4.8%). Four patients (1.9%) had pancytopenia. Age distrubutions of the patients with and without hematological involvement were similar (p=0.6). In patients presented with fever, hepatomegaly and splenomegaly, hematologic involvement was significantly higher (p < 0.05). Hematological involvement was higher in patients who had elevated aspartate aminotransferase and alanine aminotransferase concentrations (p < 0.05). Hematological involvement was higher in patients with positive blood culture (p=0.005). Six patients (2.8%) were treated with intravenous immunoglobulin at 1000 mg/kg/day for two days in addition to anti-brucellosis treatment. Hematological involvement in brucellosis is a common finding regardless of age, especially in febrile, bacteremic patients and in patients who had hepatosplenomegaly and elevated liver enzymes. Anemia is the most common hematological abnormality.

Neurobrucellosis: Brief Review.

Brucella are small, nonmotile, intracellular, and aerobic gram-negative bacteria. Of the 10 species that currently form the genus Brucella, 5 were shown to be pathogenic in humans. The epidemiology, clinical manifestations, diagnosis and imaging, and treatment of neurobrucellosis will be reviewed.Brucellosis's transmission to humans occurs by direct contact with contaminated animals. Older patients are at increased risk of nervous system involvement in brucellosis. Brucella spp. can lead to central nervous system involvement through direct damage via invasion of neural tissue or indirect damage caused by endotoxins or immune inflammatory reactions elicited by the presence of the bacteria in the body. Patients can have general nonspecific symptoms in addition to neurological and psychiatric symptoms. There are 4 diagnostic criteria for the diagnosis of neurobrucellosis, which include signs and symptoms suggestive of neurobrucellosis, a positive finding of Brucella spp. in the cerebrospinal fluid (CSF), and/or a positive titer of antibodies targeting brucella in the CSF, lymphocytosis with high protein levels and low glucose levels in CSF, and imaging findings (either cranial magnetic resonance imaging or computed tomography) peculiar to neurobrucellosis. For the treatment, a combined therapy is favored over monotherapy for the eradication of Brucella. Moreover, a multirouted therapy has been associated with increased treatment efficacy. The prognosis of neurobrucellosis is dependent on patients' clinical presentation: brucellar meningitis is associated with a good prognosis, whereas diffuse central nervous system involvement is associated with the development of long-term sequelae. Neurobrucellosis affects patients globally and in endemic areas. Neurologists should familiarize themselves with its clinical presentation, diagnosis, and treatment to provide optimal care for their patients.

Intermediate uveitis

Brucellosis is endemic to India but remains highly underdiagnosed. We report an unusual case of intermediate uveitis with Brucella etiology (BE). A 45-year old female from eastern India complains of diminution of vision and floaters in both eyes (BE), worsening over the last 6 months. Previously, she received on and off oral steroids for 2 years. Her BCVA in right eye (RE) was 20/160 and left eye (LE) was 20/200. She had old keratic precipitates, posterior subcapsular cataract, and vitritis in BE. On ELISA, she was positive for Brucella IgM antibodies. Subsequently, oral antibiotics improved her vision. Ocular involvement in brucellosis, can cause severe vision-threatening complications. An early diagnosis of brucellosis can thus save sight.

Evaluation of Bone and Joint Involvement in Patients Followed with the Diagnosis of Brucellosis

Aim: Brucellosis is an important problem all over the world. The most common form is bone-joint involvement. In this study, we planned to reveal our experiences by examining the epidemiological, clinical, laboratory and radiological features of brucellosis cases with and without bone-joint involvement. Material and Methods: This retrospective clinical study includes the data of 443 patients who were followed up with the diagnosis of brucellosis between December 2014 and August 2019. The epidemiological, clinical, laboratory and radiological findings of the patients were obtained from the patient files and hospital database. Patients were divided into two groups as with and without bone-joint involvement and their data were compared statistically. Results: A total of 443 patients who were followed up with a diagnosis of brucellosis were included in the study. 92 (20.8%) of these patients had bone-joint involvement of brucellosis (sacroileitis, spondylodiscitis, arthritis, bursitis, synovitis). Magnetic resonance imaging method was used for diagnosis in patients with bone-joint involvement. Patients with bone-joint involvement had longer duration of complaints, and acute phase reactants and agglutination titers were higher. Conclusion: Bone-joint involvement in brucellosis is very important as it may cause inadequate treatment and may end with sequelae. Radiological imaging is important in the diagnosis of bone-joint involvement, but unnecessary requests should also be avoided. Symptom duration, acute phase reactants, agglutination titer may be guiding for this.

Risk factors for focal involvement in brucellosis

PurposeWe aimed to evaluate the risk factors of focal involvement in brucellosis. MethodsThe data of brucellosis patients were analyzed retrospectively from 2010 through 2019. Patients were divided into two groups: focal involvement (−) and focal involvement (+). The clinical findings, complications and laboratory findings of patients were compared between the two groups. ResultsTwo hundred thirty patients were included in the study. One hundred twenty-seven of the patients (55.2%) were male and mean age was 45.8 ± 17.1 (16–86) years. Focal involvement was observed in 98 (42.6%) patients. The variables that differed significantly between groups were age (P < 0.001), fever (P = 0.016), back pain (P < 0.001), leukocyte (P = 0.012), neutrophil (P = 0.004), platelet (P = 0.002), mean platelet volume (MPV) (P = 0.043) and erythrocyte sedimentation rate (ESR) (P = 0.001). Older age (>45 years) and back pain were found to be independent risk factors for predicting focal involvement (P = 0.036 and P < 0.001). ConclusionsThe clinical findings and markers that are significant in determining focal involvement may be useful in identifying complicated brucellosis.

Immunopathogenesis of Hepatic Brucellosis.

The hepatic immune system can induce rapid and controlled responses to pathogenic microorganisms and tumor cells. Accordingly, most of the microorganisms that reach the liver through the blood are eliminated. However, some of them, including Brucella spp., take advantage of the immunotolerant capacity of the liver to persist in the host. Brucella has a predilection for surviving in the reticuloendothelial system, with the liver being the largest organ of this system in the human body. Therefore, its involvement in brucellosis is practically invariable. In patients with active brucellosis, the liver is commonly affected, and the most frequent clinical manifestation is hepatosplenomegaly. The molecular mechanisms implicated in liver damage have been recently elucidated. It has been demonstrated how Brucella interacts with hepatocytes inducing its death by apoptosis. The inflammatory microenvironment and the direct effect of Brucella on hepatic stellate cells (HSC) induce their activation and turn these cells from its quiescent form to their fibrogenic phenotype. This HSC activation induced by Brucella infection relies on the presence of a functional type IV secretion system and the effector protein BPE005 through a mechanism involved in the activation of the autophagic pathway. Finally, the molecular mechanisms of liver brucellosis observed so far are shedding light on how the interaction of Brucella with liver cells may play an important role in the discovery of new targets to control the infection. In this review, we report the current understanding of the interaction between liver structural cells and immune system cells during Brucella infection.

Extensive cranial, spinal and abdominal involvement in brucellosis: a case with review of the literature

Brucellosis is still an endemic disease in certain parts of world. It’s clinical and radiological features are crucial for an accurate diagnosis. Although systemic disease in brucellosis shows common typical features, it’s also very important to know the uncommon features of multisystemic involvement. Herein we present a case of brucellosis with unique imaging features of extensive cranial, spinal, abdominal involvement in a middle aged woman.

Molecular Diagnostic Methods of Brucellosis: a Note on Pitfalls

Clinical manifestations of the brucellosis may show extensive appearance because of its wide signs and symptoms. Patients with brucellosis are usually symptomatically treated by using different antibiotics at private clinics due to misdiagnosis of clinical laboratory findings specially those chronic forms. These subjects will have been hospitalized with a complicated form of signs after changing a few therapies (1). At this time, classical methods such as culture based and serological procedures could not alone meet of clinicians’ demands. Many researchers have been being tried to introduce an alternative method better in accuracy, reliability and efficiency aspects. However, most reported comparison studies were not able to present desired results. There are not any significant points in existence of various and even contradictory results in laboratory interpretation reports. Those patients with recent brucellosis involvement or acute disease are better diagnosed than those hospitalized or chronic cases. Unfortunately, it is being observed the most researchers are not attending the patient clinical infectious form. Obviously, in-patients have more problematical conditions that results to have lower sensitivity rate in some test or even different from each other. Unfortunately, this concern has not been noticed in the majority of molecular epidemiology studies. Analyzed results of various tests are not fully in agreement with each other in these reports, confirming each test is better suited for some specific clinical conditions (2). Another important problem is applying home brew protocols in all comparative studies. This type of non-commercial diagnostic protocol are being surprisingly applied in most small Iranian clinical laboratories. These assays have been being followed from some reported papers without any proper optimization experiments or exact clinical trial specifically for Iranian populations, particularly when several of the effective parameters in the optimization may not be well reflected in these released reports. Some of them for proper optimization and standardization are mentioned in other studies (3). Proper selecting sampling is additional problems. Serum specimens would not be preferred samples since Brucella spp. agents are intracellular which is integrated in PMN cells. Serum specimens may give positive results, but in those has high antibody titer or acute cases. Although it is used as applied specimens instead of peripheral anti-coagulated blood (4). The chance of the recovery Brucella spp. DNA is obviously reduced in those chronic and complicated subjects. In addition, sampling from patients undergoing treatment may have low positive predictive value results (5,6). It would seem international approved extraction method accompanied with internal control as control the DNA isolation procedure and to check for possible PCR inhibition should be used in molecular diagnostic settings (4,7). Finally the last point, various pathogenic Brucella species involve in many countries. At present, we have no significant documentary reports in frequency rate of Brucella spp. in our community. Some reports represent considerable rate for B. abortus while some not. Therefore, applied protocol must be enough sensitive to detect and even differentiate at least B. abortus from B. melitensis, although some reports illustrate the presence of B. canis as well as in Iran (8).

Lung Involvement in Brucellosis

Lung Involvement in Brucellosis

Neurobrucellosis with Acquired Hemophagocytic Lymphohistiocytosis in a Two-Year-Old Bolivian Male

Hemophagocytic lymphohistiocytosis (HLH) is a rare hyper-inflammatory syndrome that may be inherited or acquired. HLH may be a complication of infectious disease, including brucellosis. Central nervous system involvement in brucellosis is uncommon, occurring in only 5-7% of cases. In this report we describe a case of neurobrucellosis with acquired HLH in a two-year-old Bolivian male. The patient presented to the emergency department with recurrent fevers, malaise, anorexia, and abdominal distention. HLH was suspected due to hepatosplenomegaly, fever, and evidence of hemophagocytosis in a previous bone marrow biopsy. Pancytopenia, increased ferritin, and increased transaminases were observed in laboratory workups, which along with hepatosplenomegaly are consistent with HLH. Positive blood cultures and PCR identification of Brucella melitensis indicated the cause of HLH. Magnetic resonance imaging (MRI) results and analysis of cerebrospinal fluid indicated neural involvement. Treatment of neurobrucellosis with rifampin, gentamicin, doxycycline, and ceftriaxone resolved the infection, which in turn resolved the HLH. This case demonstrates the importance of considering brucellosis as a differential diagnosis of HLH. ABBREVIATIONS:HLH - Hemophagocytic lymphohistiocytosis, WBC - White blood cell, RBC - Red blood cell, ALT - Alanine aminotransferase, AST - Aspartate aminotransferase, ALP - Alkaline phosphatase, LDH - Lactate dehydrogenase, PCR - Polymerase Chain Reaction, CBC - Complete blood count, TNF-α - Tumor necrosis factor-α

Valvular involvement in brucellosis

Introduction: Brucella endocarditis, although an uncommon complication of brucellosis, is the main cause of the mortality related to this disease. The best therapy is a combination of antibiotic administration with valve replacement. After treatment of the first episode of endocarditis, new infection may be occurred as a relapse or reinfection. Case Presentation: In this report, we described a patient with brucella endocarditis complicated with a reinfection of the mechanical prosthetic valve after one year of follow-up. Conclusions: Both medical and surgical management should be done for better treatment of brucella endocarditis. Repeat infection is a problem during follow-up.

Valvular involvement in brucellosis

Introduction: Brucella endocarditis, although an uncommon complication of brucellosis, is the main cause of the mortality related to this disease. The best therapy is a combination of antibiotic administration with valve replacement. After treatment of the first episode of endocarditis, new infection may be occurred as a relapse or reinfection. Case Presentation: In this report, we described a patient with brucella endocarditis complicated with a reinfection of the mechanical prosthetic valve after one year of follow-up. Conclusions: Both medical and surgical management should be done for better treatment of brucella endocarditis. Repeat infection is a problem during follow-up.