Human brucellosis has a broad spectrum of clinical manifestations, which includes endocarditis, a focal complication that is uncommon yet responsible for the majority of associated deaths. The most successful treatment outcomes of Brucella endocarditis have been reported with usage of both antimicrobial agents and surgery. However, there are few reports on the treatment of Brucella endocarditis using antibiotics only. We report the first case in Korea of Brucella endocarditis with aortic valve vegetations and an accompanying splenic abscess, which were treated successfully with antibiotic therapy alone.
Abscess/*microbiology ; Animals ; Aortic Valve/microbiology ; *Brucella abortus ; Brucellosis/*diagnosis ; Cattle ; Dairying ; Endocarditis/*microbiology ; Humans ; Korea ; Male ; Middle Aged ; Occupational Diseases/*microbiology ; Spleen/microbiology ; Zoonoses

Adult ; Aortic Valve ; microbiology ; pathology ; Autopsy ; Brain ; microbiology ; pathology ; Endocarditis, Bacterial ; complications ; microbiology ; pathology ; Female ; Heart Ventricles ; microbiology ; pathology ; Humans ; Mitral Valve ; pathology ; Sepsis ; complications ; microbiology ; pathology ; Substance Abuse, Intravenous ; complications ; microbiology ; pathology ; Young Adult

PURPOSE: This study was conducted to evaluate the surgical outcomes of active infective endocarditis with aortic root abscess formation. MATERIALS AND METHODS: Between February 1999 and June 2012, 49 patients underwent surgery for active endocarditis with aortic root abscess. The infected valve was native in 29 patients and prosthetic in 20 patients. The patients' mean age was 50+/-14 years, and 36 patients were male. Surgery was urgent/emergent in 15 patients (31%). The abscess involved the aortic annulus (11), left ventricular outflow tract (18), fibrous trigone (16), and mitral annulus (4). In all patients, wide debridement of abscess and aortic valve replacement with or without patch reconstruction of aortic root or annulus was performed. RESULTS: There were 6 (12%) operative deaths. Causes of early mortality were sepsis (2) and multi-organ failure (4). On postoperative echocardiogram, there was significant improvement of left ventricular dimension (LVEDD, from 58.8+/-11.8 mm to 52.6+/-8.2 mm, p<0.001); however, LV ejection fraction was significantly decreased (from 61.4+/-12.0% to 49.8+/-16.5%, p<0.001). The mean follow-up duration was 68.7+/-40.4 months. There was no late death or recurrent endocarditis during follow up. New York Heart Association functional class significantly improved from 3.2+/-0.7 to 1.2+/-0.4 (p<0.001). Kaplan-Meier estimated survival at 10 years was 87.2%. CONCLUSION: Surgical treatment for active endocarditis with aortic root abscess is still challenging, and was associated with high operative mortality. Nevertheless, long-term survival was excellent with good functional capacity after recovery from the early postoperative period.
Abscess/*surgery ; Adult ; Aortic Valve/microbiology/*surgery ; Debridement ; Endocarditis/*surgery ; Female ; Follow-Up Studies ; Heart Valve Prosthesis/*microbiology ; Heart Valve Prosthesis Implantation/*adverse effects/mortality ; Humans ; Intraoperative Complications/epidemiology ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Postoperative Complications/epidemiology ; Retrospective Studies

No abstract available.
Aged ; Anti-Bacterial Agents/therapeutic use ; Aortic Valve/*microbiology/surgery/ultrasonography ; Cross Infection/diagnosis/*microbiology/therapy ; Diffusion Magnetic Resonance Imaging ; Endocarditis, Bacterial/diagnosis/*microbiology/therapy ; Heart Valve Prosthesis Implantation ; Humans ; Klebsiella Infections/diagnosis/*microbiology/therapy ; Klebsiella pneumoniae/drug effects/*enzymology/pathogenicity ; Male ; Microbial Sensitivity Tests ; Predictive Value of Tests ; Sepsis/diagnosis/*microbiology/therapy ; Treatment Outcome ; beta-Lactamases/*metabolism

Abscess ; Adult ; Anti-Bacterial Agents ; therapeutic use ; Aortic Valve ; diagnostic imaging ; microbiology ; pathology ; Echocardiography, Transesophageal ; methods ; Edema, Cardiac ; diagnostic imaging ; drug therapy ; pathology ; Endocarditis, Bacterial ; diagnostic imaging ; drug therapy ; Gentamicins ; therapeutic use ; Humans ; Male ; Mitral Valve ; diagnostic imaging ; pathology ; Tricuspid Valve ; diagnostic imaging ; pathology ; Vascular Fistula

Since microbial gene sequencing was utilized for etiologic diagnosis of culture-negative endocarditis, cases of Bartonella endocarditis have been reported in various countries. Herein we report the first case of Bartonella quintana endocarditis, which was confirmed for the first time in Korea by 16S rRNA gene sequencing from the excised valve. A 75-yr-old woman was hospitalized due to dyspnea. Echocardiography demonstrated large oscillating vegetation at the aortic valve. Blood culture was negative. She underwent valve replacement and sequencing of the 16S rRNA gene from excised valve identified Bartonella quintana. She was successfully treated with combined use of ceftriaxone and gentamicin.
Aged, 80 and over ; Anti-Bacterial Agents/therapeutic use ; Aortic Valve/pathology ; Bartonella quintana/genetics/*isolation & purification ; Ceftriaxone/therapeutic use ; Drug Therapy, Combination ; Dyspnea/etiology ; Echocardiography ; Endocarditis, Bacterial/*diagnosis/drug therapy/microbiology ; Female ; Gentamicins/therapeutic use ; Humans ; RNA, Ribosomal, 16S/genetics ; Republic of Korea ; Sequence Analysis, RNA