Brucella Infection Associated with Complete Atrioventricular Block

Abstract

Background: The clinical spectrum of Brucella infection is quite diverse and characterized by multi-system involvement. Patients present with myocarditis, endocarditis, or pericarditis. Infective endocarditis is the most common cardiovascular complication in patients with brucellosis. Although conduction abnormalities are seen in cases with endocarditis, they are reported very rarely in the setting of cardiac Brucella infection. Case Report: An eight and a half-year-old male patient was referred to our clinic due to inadequate response to cotrimaxazole plus streptomycin treatment at the 15th day of admission. Although local hospital records on the patient showed a heart rate of 80 bpm, we determined a heart rate of 46 bpm. The electrocardiogram showed complete atrioventricular (AV) block. The average heart rate was determined as 48 bpm with 24-hour Holter electrocardiogram (ECG) monitoring. The echocardiographic examination showed normal-sized heart chambers and the absence of valvular involvement. An agglutination test for brucellosis was found to be positive with a titer of 1/320. High fever, arthralgia, and splenomegaly regressed following doxycycline plus rifampicin therapy, but there was no improvement in the AV block. A permanent pacemaker was implanted because of the detection of an average heart rate of 48 bpm. Conclusion: Because cardiac failure and rhythm abnormalities are reported in the course of Brucella infection and may be associated with significant outcomes, cases with brucellosis should be evaluated carefully in terms of cardiac involvement. This report aims to draw attention to complete AV block as an extremely rare complication of Brucella infection.

Keywords

• Brucella infection, atrioventricular block, myocarditis, child

References

1. 1. Abid L, Frikha Z, Kallel S, Chokri Z, Ismahen B, Amin B, et al. Brucella Myocarditis: A rare and life-threatening cardiac complication of Brucellosis. Intern Med 2012;51:901-4. [CrossRef]
2. 2. Shah FS, Fennelly G, Weingarten-Arams J, Yang L, Glickstein J. Endocardial abscesses in children: case report and review of the literature. Clin Infect Dis 1999;29:1478-82. [CrossRef]
3. 3. D’Agrosa MC, Lusson JR, Beytout J, Bailly P, Peycelon B, de Riberolles C, et al. Brucella endocarditis caused by reinfection of an aortic Starr valve. Apropos of a case with a favorable development after valvular replacement. Arch Mal Coeur Vaiss 1988;11:1403-7.
4. 4. Kaya O, Avşar K, Akçam FZ. Unusual manifestations of brucellosis. Arch Med Sci 2011;7:173-5. [CrossRef]
5. 5. Bukharie HA. Clinical features, complications and treatment outcome of Brucella infection: ten years’ experience in an endemic area. Trop J Pharm Res 2009;8:303-10. [CrossRef]
6. 6. Colmenero JD, Reguera JM, Martos F, Sánchez-De-Mora D, Delgado M, Causse M. et al. Complications associated with Brucella mellitensis infection: a study of 530 cases. Medicine (Baltimore) 1996;75:195-210. [CrossRef]
7. 7. Lulu AR, Araj GF, Khateeb MI, Mustafa MY, Yusuf AR, Fenech FF. Human Brucellosis in Kuwait: a prospective study of 400 cases. Q J Med 1988;66:39-54.
8. 8. Sharifkazemi MB, Moarref AR, Rezaian S, Rezaian GR. Brucella endocarditis of pseudoaneurysm of an aortic composite graft. J Cardiovasc Ultrasound 2013;21:183-5. [CrossRef]

9. 9. Yazıcı HU, Mert KU, Senol U, Ulus T. A case with tricuspid valve brucella endocarditis presenting with acute right heart failure Arch. Turk Kariyol Dern Ars 2012;40:364-7. [CrossRef]