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Vojnosanitetski pregled
2012, vol. 69, br. 8, str. 725-729
jezik rada: engleski
vrsta rada: prikaz slučaja
doi:10.2298/VSP111007020O


Endokarditis mitralnog zaliska u toku recidiva bruceloze
aFaculty of Medicine, Belgrade + Clinical Center of Serbia, Clinic of Cardiology, Belgrade
bFaculty of Medicine, Belgrade + Clinical Center of Serbia, Clinic of Cardiac Surgery, Belgrade
cFaculty of Medicine, Belgrade + Clinical Center of Serbia, Clinic of Infectious and Tropical, Belgrade
dClinical Center of Serbia, Center for Anaesthesia, Belgrade
eUniverzitet u Beogradu, Medicinski fakultet, Klinički centar Srbije

e-adresa: biljanaok@yahoo.com

Sažetak

Uvod. Endokarditis je najčešća kardiovaskularna manifestacija bruceloze i ima visoku stopu mortaliteta. Brucella je intracelularni patogen, što je čini slabije dostupnom za antibiotike (mada ne za sve), pa se relaps može javiti posle različito dugog klinički latentnog perioda. Prikaz bolesnika. Poljoprovredniku, starom 55 godina, postavljena je dijagnoza bruceloze u regionalnoj bolnici u maju 2008. i lečen je antibioticima dva meseca, kao i dva meseca posle otpusta. Međutim, osam meseci posle pojave inicijalnih simptoma bolesnik je osetio bolove u mišićima i kostima, slabost, otežano disanje, bolove u trbuhu, mučninu, povraćao je i imao dijareju, kao i smanjenje telesne mase. Zbog pogoršanja simptoma primljen je u februaru 2009. u kardiološku kliniku. Na osnovu kombinovanih epidemioloških, kliničkih podataka (na prijemu kahektičan, adinamičan, dispnoičan, hipotenzivan 80/50 mmHg, febrilan do 39,5°C), pozitivnog Wright-ovog serološkog testa za brucelozu (1:5120) i ehokardiografskog nalaza, postavljena je dijagnoza veoma teškog recidiva bruceloze sa endokarditisom mitralnog zaliska, komplikovanog perforacijom prednjeg mitralnog zaliska, teškom mitralnom regurgitacijom i plućnom hipertenzijom. Bolesnik je lečen trojnom antibiotskom terapijom (vankomicin, ciprofloksacin i gentamicin, promenjeni u režim sa kombinacijom doksiciklin, gentamicin i imipenem, uz kasniju zamenu gentamicina rifampicinom) tokom četiri nedelje, a sledeće dve nedelje kombinacijom trimetoprim/ sulfametoksazol i rifampicin. Stanje bolesnika bilo je bolje, pa je operisan. Mitralni zalistak je zamenjen i nastavljeno je sa kombinovanom trojnom antibiotskom terapijom (amikacin + ciprofloksacin + cefazolin, dve nedelje i cefazolin + doksiciklin + rifampicin, 2 nedelje), uz kasniju primenu dvojne antibiotske terapije (doksicikline + rifampicin) tokom 5 meseci. Bolesnik se oporavio 30 meseci posle operacije, bez ikakvih znakova infekcije. Zaključak. Kombinacija antibiotskog i hirurškog lečenja može smanjiti komplikacije i mortalitet koji prati brucelozni endokarditis i, takođe, može poboljšati kvalitet života bolesnika.

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