Yonsei Med J.  2009 Feb;50(1):142-146. 10.3349/ymj.2009.50.1.142.

Brucella Endocarditis with Splenic Abscess: A Report of the First Case Diagnosed in Korea

• Park SH
• Choi YS
• Choi YJ
• Cho SH
• Yoon HJ

• KMID: 1782980
• DOI: http://doi.org/10.3349/ymj.2009.50.1.142

Abstract

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.

Keyword

Brucellosis; endocarditis; Brucella abortus; treatment; splenic abscess

MeSH Terms

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

Figure

• 

  Fig. 1 (A) Contrast-enhanced abdomen CT scan reveals partial splenic abscess that is a wedge shape (arrow) and splenomegaly. (B) Twelve months later, follow-up CT scan reveals normalized spleen size of about 11 cm compared with the previous splenomegaly size of 15 cm. A portion of the splenic abscess changed into cortical dimpling (arrow) with segmental shrinkage.

• 

  Fig. 2 (A) Transesophageal echocardiography reveals one vegetation (4 × 2 mm, arrow) on the right aortic coronary cusp and the other vegetation (5 × 3 mm, arrow head) on the noncoronary aortic cusp upon admission. (B) Two months later, follow up transesophageal echocardiography (TEE) reveals no interval change of the vegetation (arrow) size within the noncoronary cusp, but vegetation within the right coronary cusp was completely resolved. (C) Seven months later, follow up TEE shows complete resolution of the remained vegetation.

• 

  Fig. 3 Genus-specific PCR. Molecular diagnostic assays based on PCR amplification of different genomic targets for the identification of Brucella spp. tested of the isolate. The clinical isolate was tested by the conventional biochemical tests and detected with common genes (BCSP-31 kDa, OMP2-36kDa, 16S rRNA) of Brucella spp. M, 100 bp marker; Lane 1, Brucella abortus ATCC 2308; Lane 2, Patient's isolate.

• 

  Fig. 4 Species-specific AMOS-Multi-PCR. We have adopted Multiplex AMOS-PCR method for the species-specific typing of clinical isolate. In the profile of Multiplex AMOS-PCR, B. abortus (biovar 1, 2, 3, 4, 6), B. melitensis (biovar 1, 2), B. canis, and B. suis (biovar 3) showed characterization patterns into the respective species and four different amplification patterns were observed. Multiplex AMOS-PCR patterns I (200, 600 and 900 bp) were B. melitensis (biovar 1, 2), B. abortus (biovar 3, 6), patterns II (200, 600 and 720 bp) were B. abortus (biovar 1, 2, 4), patterns III (600 and 900 bp) were B. canis, B. suis (biovar 3) and patterns IV (200, 720 and 900 bp) were B. abortus ATCC 7705. The clinical isolate of our patient had identical patterns as B. abortus biovar 1 (patterns II). Lane 1, 100 bp ladder; Lane 2 & 3, B. melitensis; Lane 4, B. abortus ATCC 7705; Lane 5, B. abortus bv.1; Lane 6, B. abortus bv. 3; Lane 7, B. abortus bv.6; Lane 8, B. abortus bv.2; Lane 9, B. abortus bv4; Lane 10, S19; Lane 11, RB51; Lane 12, B. canis; Lane 13, B. suis; Lane 14, B. ovis; Lane 15, other patient's isolate (B. abortus bv.1); Lane 16, our patient's isolate.

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