Infective endocarditis caused by Brucella melitensis in an HIV-positive patient

IF 0.3 Q4 INFECTIOUS DISEASES HIV & AIDS Review Pub Date : 2021-01-01 DOI:10.5114/HIVAR.2021.107241
H. S. N. Setty, A. Trivedi, J. Kharge, Sathwik Raj, Phani Teja Mundru, Santhosh Jadav, Y. M. Channabasappa, S. Shankar, T. R. Raghu, R. Patil, C. Manjunath
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Abstract

Introduction: Cardiac complications are becoming more critical in patients with human immunodeficiency virus (HIV) infection. The risk of infectious complications in HIV-positive patients has decreased with the availability of highly active antiretroviral therapy, but remains high in developing countries, such as India. HIV patients are at increased risk for recurrent bacterial infections due to acquired immune suppression. Case presentation: We describe a case of a 45-year-old HIV-infected male, on antiretroviral therapy for 4 years, with invasive endocarditis. On admission, his CD4+ count was 274 cells/μl. The patient was hemodynamically stable on arrival and was in congestive heart failure. Pallor was present with no peripheral signs of infective endocarditis. 2D echocardiogram revealed vegetations on the tips of anterior and posterior leaflets of the mitral valve, severe mitral regurgitation, and moderate tricuspid regurgitation. Blood culture was positive for Brucella melitensis . The patient recovered without any sequel after six weeks of antibiotic therapy (gentamycin intravenously + rifampicin p.o.). The patient remains under regular follow-up. Conclusions: Brucellosis in general is a difficult diagnosis to make. Therefore, along with diagnosis, treatment is also delayed leading to devastating outcomes. Cardiac involvement occurs in only 2% of cases but accounts for 80% of mortality due to brucellosis. Brucella endocarditis should be suspected in HIV patients with endocarditis, who have negative blood cultures and risk of exposure. The most accepted treatment for B. endocarditis is a combination of anti-microbial therapy with surgery.
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hiv阳性患者由梅利特布鲁氏菌引起的感染性心内膜炎
心脏并发症在人类免疫缺陷病毒(HIV)感染患者中变得越来越重要。随着高活性抗逆转录病毒疗法的可用性,艾滋病毒阳性患者感染并发症的风险已经降低,但在印度等发展中国家仍然很高。由于获得性免疫抑制,艾滋病毒患者复发性细菌感染的风险增加。病例介绍:我们描述了一个45岁的艾滋病毒感染的男性,抗逆转录病毒治疗4年,侵袭性心内膜炎。入院时CD4+计数274个/μl。患者到达时血流动力学稳定,但有充血性心力衰竭。面色苍白,周围无感染性心内膜炎征象。二维超声心动图显示二尖瓣前后叶尖部赘生物,严重二尖瓣反流,中度三尖瓣反流。血培养阳性的布鲁氏菌。患者经6周抗生素治疗(静脉注射庆大霉素+利福平)后恢复,无任何后遗症。病人仍在接受定期随访。结论:一般来说,布鲁氏菌病是一种难以诊断的疾病。因此,随着诊断,治疗也被延误,导致毁灭性的后果。累及心脏的病例仅占2%,但占布鲁氏菌病死亡率的80%。布鲁氏菌心内膜炎应怀疑艾滋病毒患者心内膜炎,谁是阴性血培养和暴露的风险。治疗心内膜炎最普遍的方法是手术联合抗微生物治疗。
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来源期刊
HIV & AIDS Review
HIV & AIDS Review INFECTIOUS DISEASES-
CiteScore
0.50
自引率
0.00%
发文量
30
审稿时长
12 weeks
期刊最新文献
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