Abstract
Infection with Bartonella spp may cause cardiac arrhythmias, myocarditis and endocarditis in humans. The aim of the present study was to evaluate a possible association between Bartonella spp bacteremia and endocarditis, arrhythmia and Chagas cardiomyopathy in patients from Brazil and Argentina. We screened for the presence of bacterial 16S rRNA in human blood by PCR using oligonucleotides to amplify a 185-bp bacterial DNA fragment. Blood samples were taken from four groups of subjects in Brazil and Argentina: i) control patients without clinical disease, ii) patients with negative blood-culture endocarditis, iii) patients with arrhythmias, and iv) patients with chronic Chagas cardiomyopathy. PCR products were analyzed on 1.5% agarose gel to visualize the 185-bp fragment and then sequenced to confirm the identity of DNA. Sixty of 148 patients (40.5%) with cardiac disease and 1 of 56 subjects (1.8%) from the control group presented positive PCR amplification for Bartonella spp, suggesting a positive association of the bacteria with these diseases. Separate analysis of the four groups showed that the risk of a Brazilian patient with endocarditis being infected with Bartonella was 22 times higher than in the controls. In arrhythmic patients, the prevalence of infection was 45 times higher when compared to the same controls and 40 times higher for patients with Chagas cardiomyopathy. To the best of our knowledge this is the first report of the association between Bartonella spp bacteremia and Chagas disease. The present data may be useful for epidemiological and prevention studies in Brazil and Argentina.
Highlights
The Gram-negative organisms of the Bartonella genus are fastidious micro-aerobic bacteria classified into the second subgroup of the Proteobacteria class [1]
Hosts accidentally infected with Bartonella spp can show systemic signs, such as bacteremia and cardiac diseases mostly related to abnormalities in the heart valves, which may result in endocarditis [4,5]
A number of studies in European countries have recently demonstrated that Coxiella burnetii, B. henselae and B. quintana are significantly associated with endocarditis in patients with negative blood culture [20]
Summary
The Gram-negative organisms of the Bartonella genus are fastidious micro-aerobic bacteria classified into the second subgroup of the Proteobacteria class [1]. This genus contains about 30 species, some of which have been isolated from humans (B. bacilliformis, B. henselae, B. elizabethae, and B. quintana) and from cats and dogs (B. koehlerae and B. vinsonii berkhoffii). Hosts accidentally infected with Bartonella spp can show systemic signs, such as bacteremia and cardiac diseases mostly related to abnormalities in the heart valves, which may result in endocarditis [4,5]. Surgery may be required in 20-40% of patients with infective endocarditis, mostly for valve replacement [5,6]
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