Brucella arteritis: clinical manifestations, treatment, and prognosis

Abstract

Brucellosis is the most common bacterial zoonosis, and causes a considerable burden of disease in endemic countries. Cardiovascular involvement is the main cause of mortality due to infection with Brucella spp, and most commonly manifests as endocarditis, peripheral and cerebrovascular aneurysms, or arterial and venous thromboses. We report a case of brucellosis presenting as bacteraemia and aortic endarteritis 18 years after the last known exposure to risk factors for brucella infection. The patient was treated with doxycycline, rifampicin, and gentamicin, and underwent surgical repair of a penetrating aortic ulcer, with a good clinical recovery. We review the signs and symptoms, diagnostic approach, prognosis, and treatment of brucella arteritis. We draw attention to the absence of consensus about the optimum therapy for vascular brucellosis, and the urgent need for additional studies and renewed scientific interest in this major pathogen.

Figure 1. Vertebral lesions

CT scan showing lytic lesions in the 12th thoracic (T12) and first lumbar (L1) vertebrae (top images), and in the fifth thoracic (T5) vertebra (bottom images).

Figure 2. Invasive coronary arteriography (A) and cardiac CT scan (B)

Arrows indicate the penetrating intramural aortic ulcer immediately distal to the ostium of the left coronary artery.

Figure 3. Antibiotics used to treat brucellosis

The number of patients treated with each class of antibiotic among 30 published cases in which antibiotic regimens were described.^{–, –,,,,,,,,,} Sulfa drugs include co-trimoxazole, terfonyl, and sulfanilamide.