Brucella melitensis endocarditis: successful treatment of an infected prosthetic mitral valve.

Brucelha melitensis endocarditis: successful treatment of an infected prosthetic mitral valve. A 38-year-old man had a mitral valve replacement for rheumatic calcific mitral stenosis and regurgitation; following this operation he remained well for 10 months. He then presented with cough, abdominal pain, and rigors, and Brucella melitensis type 3 was repeatedly isolated from blood cultures. His clinical condition deteriorated rapidly and an emergency valve replacement was performed. He was then treated with co-trimoxazole for 12 months and made an excellent recovery. This is the first reported case of brucella endocarditis arising de novo on a prosthetic heart valve. Endocarditis is a rare but serious complication of brucellosis. We report here a case of Brucella melitensis type 3 endocarditis occurring in a patient with a prosthetic mitral valve. A 38-year-old Italian male restaurant proprietor underwent mitral valve replacement for rheumatic calcific mitral stenosis and regurgitation on 13 January 1972, with insertion of a No. 3 Starr Edwards mitral valve prosthesis type 6520. On the fourth day after the operation he developed a pyrexia with a rigor. Blood cultures taken at this time were sterile but it was known that at least one bottle of intravenous fluid he had received was contaminated with Pseudomonas thomasii (Phillips, Eykyn, and Laker, 1972) and he was accordingly treated with a six-week course of co-trimoxazole to which the organism was known to be sensitive. Following this, the patient made a good recovery and remained well for 10 months, requiring only routine maintenance doses of digoxin and warfarin. In November 1972, he developed a febrile illness with rigors and complained of cough and abdominal pain, and one week later he became progressively dyspnoeic on exertion and orthopnoeic. Blood was taken for culture and treatment was started with amoxycillin. However, his fever persisted and he developed left heart failure, requiring admission to St. Peter's Hospital, Chertsey on 21 November. Amoxy-cillin was discontinued and further blood cultures were taken. He was transferred to St. Thomas' Hospital on 25 November where more blood cultures were taken before treatment was begun with intravenous ampi-cillin and intramuscular streptomycin as it was considered that he had endocarditis. Two days later a slow-growing oxidase-positive Gram-negative bacillus was isolated from the blood cultures taken at Chertsey. It was strongly suspected that this organism might be Ps. thomasii and the antibiotic therapy was changed to intravenous cephalexin, trimethoprim, and sulpha-diazine. However, the patient's condition deteriorated and …