Remission of brucella endocarditis in a patient with mitral valve mechanical prosthesis by antibiotic therapy alone: A case report

Brucellosis is still a frequently seen major infectious disease, particularly in theMediterranean, theMiddle East and Central and South American Countries [1]. Although typical brucellosis is easily diagnosed in endemic areas, in other regions where the incidence of Brucella is very low, definitive diagnosis of the infection is quite difficult. A patient presenting with a heart murmur who has a history of ingestion of unpasteurized milk and exposure to infected animals or animal products should be considered as having cardiac manifestations of brucellosis until proved otherwise [1]. Endocarditis and miocarditis are rare but the most serious complications of brucellosis. In infective endocarditis of brucellosis, Brucella melitensis and Brucella abortus are the most frequently isolated species [1]. Brucella appears to be a slowly destructive organism, with a marked tendency to tissue ulceration, the development of large vegetations carrying a significant risk of embolization and difficulty in eradicatingwithmedical therapy alone. For these reasons, optimal treatment of prosthetic valve Brucella endocarditis (BE) should achieve the sterilization of infected cardiac tissue and extensive surgical debridement without delay to control acute ilness and prevent complications and/or relapse [1]. In the present paper we report the case of prosthetic valve BE that was successfully treated with a multiple bactericidal antibiotics alone. A 49-year-old female patient was admitted to our division on march 2006 for fever (39 °C) lasting for 3 weeks. In 1995 she underwent mitral valve replacement with mechanical prosthesis for rheumatic endocarditis. Laboratory tests showed: 1) increase in: erythrocyte sedimentation rate (70 mm/h), C-