Brucella ENDOCARDITIS is a rare, and life threatening complication of human brucellosis. Children are usually infected by consumption of contaminated dairy product. Clinical presentation is similar to rheumatic fever. Aortic valve is most commonly involved. Clinical manifestations of fever, arthritis/arthralgia, aortic insufficiency, echocardiographic evidence of vegetation, and negative findings of blood culture, in a case with suspicious contact should suggest the diagnosis. Perioperative antibiotics combined with surgical treatment are an effective management. In pediatric age group, surgical techniques using biologic valves and preservation of native valves are preferred.

Infective ENDOCARDITIS is one of the most severe complications of parenteral drug abuse. The outstanding clinical feature of infective ENDOCARDITIS in intravenous drug abusers is the high incidence of right-sided valve infection, and the tricuspid valve is involved in 60% to 70% of the cases. We herein report a case of isolated pulmonic valve infective ENDOCARDITIS with a native pulmonary valve.

Enterococci are normal inhabitants of gastrointestinal tract, being responsible for 5 to 18% of infective ENDOCARDITIS and the incidence appears to be increasing. Eleven patients with enterococcal ENDOCARDITIS were studied. In a case series group, 10 men (average 57 years) and one woman (37 years) were studied. Two patients had rheumatic heart disease, 5 patients arteriosclerotic disease and one patient chronic renal failure on hemodialysis. Ten patients were treated with ampicillin and gentamycin. Valve replacement was performed in 3 patients with aortic valve ENDOCARDITIS, one on 8th day and two at the end of the treatment. Overall clinical cure was achieved in 9 patients. Two relapses occurred and 2 patients died as a result of refractory congestive heart failure and cerebral emboli. All of the enterococcal ENDOCARDITIS cases were community acquired. In conclusion, infective ENDOCARDITIS in patients with preexistent valvular heart disease, community acquisition and non specific symptoms with bacteriuria should be considered as enterococcal ENDOCARDITIS.

Introduction: Intravenous drug use is an increasing social challenge and a predisposing condition to infective ENDOCARDITIS. Data on infective ENDOCARDITIS in intravenous drug users in our society are limited. The aim of this study is determining the clinical features, site of involvement and bacteriologic findings of infective ENDOCARDITIS in intravenous drug users.Materials and Methods: In this descriptive study, injection drug users who admitted at Infectious Diseases Ward, Imam Reza Hospital in a 5 years period (2001-2005), were reviewed and patients characteristics, the results of blood cultures, echocardiographic study, chest imaging and other standard blood testing were collected in questionnaires. Statistical analysis of data was done by SPSS-11 software.Results: A total of 38 cases of infective ENDOCARDITIS occurred in 34 patients. All of these patients were men with a mean (+/- SD) age of 30.4 +/- 7.1 years. The tricuspid valve was involved in 26 cases (74.3%), the mitral valve in 4 cases (11.4%), the mitral and tricuspid valve in 4 cases (11.4%), and the mitral and aortic valve in 1 case (2.9%). The blood cultures were negative in 28.9% 0f cases; microorganisms identified in positive blood cultures included Staphylococcus aureus (77.8%, MRSA in 33.3% and MSSA in 44.4% of cases), Enterococcus (7.4%), Streptococcus pyogenes (7.4%) and Klebsiella pneumoniae (7.4%). Eight patients (21.1%) underwent surgery, and nine (23.7%) of patients died.Conclusion: Infective ENDOCARDITIS in intravenous drug users affects the right side of the heart more commonly. Staphylococcus aureus is still the most frequent organism isolated from blood cultures, but the frequency of methicillin resistant staphylococci, organisms with higher resistance to medical therapy, is increasing. Thus, the suggested empirical regimen for the treatment of infectious ENDOCARDITIS is a combination of cloxacillin, gentamycin and vancomycin. This regimen would be changed on the basis of the results of the blood culture and the pattern of antibiotic susceptibility.