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Combined brucella melitensis and streptococcal viridans endocarditis
Tarig S Al-Khuwaitir1, Bashir A Wani, Suphia M Sherbeeni
1Department of Medicine, Riyadh Medical Complex, PO Box 3847, Riyadh 11481, Kingdom of Saudi Arabia. tsa@naseej.com.sa
Abstract:
Infectious endocarditis is a potentially lethal inflammation of the hearts' inner lining invaded by microorganisms. The mortality from this illness increases as the number of infective organisms rises to 2, due to involvement of the left side of the heart. These microorganisms usually arise from the patient's own flora but can be acquired from the environment. Fever and heart murmurs are the principal clinical manifestations followed by a plethora of peripheral signs due to dissemination of microorganisms via the bloodstream. Echocardiographic imaging and sensitive culture techniques form the cornerstone of diagnosis. We report a patient with rheumatic heart disease who had combined brucella melitensis and streptococcus viridans endocarditis complicated by heart failure and an aortic root abscess. He was diagnosed on the basis of a history of prolonged fever and occupational risk as a shepherd, the presence of heart murmurs, positive blood cultures and echocardiographic evidence of aortic vegetations. He had an excellent response to intravenous antibiotic therapy combined with aortic valve replacement, which nowadays is regarded as the safest therapeutic approach for aortic valve endocarditis.
Insights
Infectious endocarditis, an inflammation of the heart lining, can be fatal. This case highlights combined Brucella and Streptococcus endocarditis, successfully treated with antibiotics and valve replacement.
Area of Science:
- Cardiology
- Infectious Diseases
- Microbiology
Background:
- Infectious endocarditis is a severe inflammation of the heart's inner lining caused by microbial invasion.
- Mortality rates escalate with left-sided heart involvement and higher microbial loads.
- Microorganisms can originate from endogenous flora or environmental exposure.
Observation:
- Fever and heart murmurs are key clinical signs, often accompanied by peripheral manifestations of systemic microbial dissemination.
- Diagnosis relies on echocardiography and sensitive blood cultures.
- A case of rheumatic heart disease presented with combined Brucella melitensis and Streptococcus viridans endocarditis, complicated by heart failure and aortic root abscess.
Findings:
- Diagnosis was established through prolonged fever, occupational history (shepherd), heart murmurs, positive blood cultures, and echocardiographic evidence of aortic vegetations.
- The patient demonstrated an excellent response to a treatment regimen.
- Combined intravenous antibiotic therapy and aortic valve replacement were employed.
Implications:
- This case underscores the importance of considering combined infections in endocarditis, especially with specific risk factors.
- Prompt diagnosis and aggressive treatment, including surgical intervention when necessary, are crucial for favorable outcomes.
- Aortic valve replacement is considered a safe and effective approach for aortic valve endocarditis.