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

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.