Abstract
IntroductionBartonella spp. infection is not rare and must be considered with great care in patients with suspected infective endocarditis, particularly if regular blood cultures remain sterile. Management of these infections requires knowledge of the identification and treatment of these bacteria.Case presentationA 50-year-old Senegalese man was admitted to our Department of Cardiac Surgery with a culture-negative endocarditis. Despite valvular surgery and adequate antibiotic treatment, recurrence of the endocarditis was observed on the prosthetic mitral valve. Heart failure required circulatory support. Weaning off the circulatory support could not be attempted owing to the absence of heart recovery. Bacteriological diagnosis of Bartonella quintana endocarditis was performed by molecular methods retrospectively after the death of the patient.ConclusionsThis case report underlines the severity and difficulty of the diagnosis of Bartonella quintana endocarditis. The clinical picture suggested possible Bartonella quintana associated myocarditis, a feature that should be considered in new cases.
Highlights
Bartonella spp. infection is not rare and must be considered with great care in patients with suspected infective endocarditis, if regular blood cultures remain sterile
We report a patient with B. quintana endocarditis followed by a myocardial dysfunction which may evoke fulminant myocarditis
We report the first case of native valve endocarditis followed by immediate recurrence on a bioprosthetic valve despite adequate antibiotic treatment
Summary
Journal of Medical Case Reports 2009, 3:7325 http://jmedicalcasereports.com/jmedicalcasereports/article/view/7325 His past medical history was significant for a myocardial infarction 4 years earlier. Right heart catheterization confirmed myocardial dysfunction (pulmonary artery occlusion pressure 25 mmHg, cardiac index 1.5 L/min/m2). On initial admission to the surgical intensive care unit, his hemodynamic status was stable with blood pressure at 130/60 mmHg with epinephrine 0.8 mg/hour and dobutamine 12 μg/kg/minute. The patient died of refractory cardiac arrest on the 10th day During these 10 days, all blood cultures remained negative. Thirty days after admission to the surgical intensive care unit, Bartonella quintana grew in a blood culture. Those results were obtained after the death of the patient.
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