Bartonella Quintana Endocarditis Research Articles

Case series of 12 Bartonella quintana endocarditis from the Southwest Indian Ocean.

Bartonella spp. are fastidious bacteria frequently identified as the cause of blood culture-negative (BCN) endocarditis. However, Bartonella infections are difficult to diagnose in routine laboratory testing and their incidence is probably underestimated. We investigated the epidemiological and clinical features of Bartonella endocarditis cases diagnosed between 2009 and 2021 on Reunion Island (Southwest Indian Ocean). We retrospectively included all patients diagnosed with Bartonella endocarditis at Reunion Island University Hospital during this period. Endocarditis was diagnosed on the basis of microbiological findings, including serological tests (IFA) and PCR on cardiac valves, and the modified Duke criteria. We used then the multispacer typing (MST) method to genotype the available Bartonella strains. We report 12 cases of B. quintana endocarditis on Reunion Island (83.3% in men, median patient age: 32 years). All the patients originated from the Comoros archipelago. The traditional risk factors for B. quintana infection (homelessness, alcoholism, exposure to body lice) were absent in all but two of the patients, who reported head louse infestations in childhood. Previous heart disease leading to valve dysfunction was recorded in 50% of patients. All patients underwent cardiac valve surgery and antimicrobial therapy with a regimen including doxycycline. All patients presented high C-reactive protein concentrations, anemia and negative blood cultures. The titer of IgG antibodies against Bartonella sp. exceeded 1:800 in 42% of patients. Specific PCR on cardiac valves confirmed the diagnosis of B. quintana endocarditis in all patients. Genotyping by the MST method was performed on four strains detected in preserved excised valves and was contributive for three, which displayed the MST6 genotype. Bartonella quintana is an important cause of infective endocarditis in the Comoros archipelago and should be suspected in patients with mitral valve dysfunction and BCN from this area.

Molecular epidemiology of Bartonella quintana endocarditis in patients from Israel and Eastern Africa

BackgroundBartonella quintana is an important cause of culture-negative endocarditis. Although humans have been considered as its only reservoir, recent studies showed that macaque species are also reservoirs of B. quintana. Based on multi-locus sequence typing (MLST) B. quintana strains have been classified into 22 sequence types (STs), with 7 STs exclusively found in humans. Data regarding the molecular epidemiology of B. quintana endocarditis is limited to only 3 STs identified in 4 patients from Europe and Australia. We studied B. quintana endocarditis acquired in Eastern Africa or Israel to investigate the genetic diversity and clinical relatedness of B. quintana from distinct geographic regions.MethodsEleven patients with B. quintana endocarditis, 6 from Eastern Africa and 5 from Israel, were studied. DNA was extracted from cardiac tissue or blood specimens and analyzed by MLST based on 9 genetic loci. An evolutionary relationship between STs was visualized by a minimum spanning tree. A phylogenetic tree was constructed with the concatenated sequences (4271 bp) of the 9 loci using the maximum-likelihood method.ResultsSix strains were classified into previously described STs while 5 strains were identified for the first time and classified into new STs 23–27 which clustered with the previously reported STs 1–7 from human strains found in Australia, France, Germany, the USA, Russia, and the former Yugoslavia, without indication of geographical structuring. ST2 was the most prevalent ST, found in 5 of 15 patients with endocarditis (33.3%). ST26 appears to be a primary founder of the human lineage.ConclusionsThe new and previously reported human STs form a single human lineage, clearly separated from the other 3 B. quintana lineages of cynomolgus, rhesus, and Japanese macaques. From evolutionary perspectives, these findings support the assumption that B. quintana has co-evolved with host species to form a host-speciation pattern. ST26 is suggested herein as a primary founder of the human lineage and may be key to explore where B. quintana had first originated; ST2 is a dominant genetic type associated with B. quintana endocarditis. To confirm these findings, additional worldwide molecular epidemiological studies are required.

Bartonella quintana Endocarditis of the Aortic Valve: First case report in Turkey

Bartonella quintana Endocarditis of the Aortic Valve: First case report in Turkey

Bartonella henselae Endocarditis: An Usual Presentation of an Unusual Disease.

Bartonella species are an emerging cause of culture-negative endocarditis with more cases being diagnosed now than 25 years ago when Bartonella quintana endocarditis was first described in a patient infected with human immunodeficiency virus (HIV). Despite the disease being increasingly reported, the exact epidemiological features are not clear, with prevalence rates ranging between 2% and 10% of all cases of culture-negative endocarditis. Moreover, the mortality rate is still high, presumably because of the subacute nature and relative rareness of the disease. Bartonella endocarditis occurs more often in men, and previous valvular surgery is a major risk factor. There is insufficient data to guide definitive treatment due to the paucity of literature. A previous study demonstrated that effective antibiotic therapy for Bartonella endocarditis should include an aminoglycoside prescribed for a minimum of 2 weeks. However, the treatment strategy is a matter of expert opinion.LEARNING POINTSBartonella endocarditis is considered one of the most common causes of culture-negative endocarditis, yet tardy diagnosis of the disease is usually made, thus carrying a high mortality rate.Awareness of the unusual presentation of Bartonella endocarditis could potentially decrease complications and mortality rates.Contact with animals, and cats in particular, is a prominent risk factor for Bartonella henselae infection. Physicians should therefore routinely enquire about such exposure when endocarditis and especially culture-negative endocarditis is suspected.Empirical therapy should be started when culture-negative endocarditis is suspected and even when Duke criteria are not met; watchful waiting for final serological tests might be harmful, as recommended by some international authors.Most organisms causing culture-negative endocarditis are not covered in the initial treatment of infective endocarditis before or without pathogen identification recommended by the European Society of Cardiology.

Starry Heart Valve: A Story Behind CAT Scratch

SESSION TITLE: Bacterial Infections 1 SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Bartonella species are zoonotic bacterial pathogens in humans. B.quintana and B.henselae are the most common agents causing human infections. B.henselae infection is associated with exposure to cats and their fleas; endocarditis may occur in patients with known valvular disease. CASE PRESENTATION: A 62-year-old female, with no prior history of heart disease, presented with 10 days of bilateral leg swelling, malaise and exertional dyspnea. She lived with her 4 cats. Examination was notable for bilateral pitting edema extending to her waist with visible scratch marks on her abdomen and lower extremities. Laboratory data revealed new pancytopenia and an elevated serum creatinine (2.1 mg/dl). She was started on clindamycin for cellulitis. Blood cultures were negative. Transthoracic echocardiogram, obtained to evaluate the severe edema, showed an aortic valve vegetation measuring 2.7 cm x 1.3 cm with aortic insufficiency. The lesion was confirmed with a transesophageal study. The patient was deemed to have culture negative endocarditis; antibiotics were changed to vancomycin, ceftriaxone and doxycycline. B.henselae and B.quintana IgG titers were positive with the titer of > 1:1024. She underwent an aortic valve replacement. PCR of the heart valve tissue was positive for Bartonella. The bacterial colonies were strongly positive by Warthin Starry stain and demonstrated strong reactivity with a Bartonella immunostain. Vancomycin and ceftriaxone were discontinued; she was transitioned to doxycycline 100 mg twice daily with rifampin 300 mg twice daily for six weeks followed by doxycycline monotherapy for 6 months. DISCUSSION: Patients with Bartonella endocarditis generally present with subacute, nonspecific symptoms including fever, fatigue, weakness, and weight loss, like our patient. Our patient’s exposure to her four cats, with frequent scratches on her thighs and lower abdomen, and a culture-negative valuvular vegetation, raised the suspicion of Bartonella endocarditis. There are several methods to confirm the presence of Bartonella infection including tissue cell culture, Warthin-Starry staining of the resected valve, immuno histologic methods, serologic testing, and PCR amplification using valve specimens. If Bartonella is proven, treatment with 6 weeks of doxycycline along with 2 weeks of gentamycin and rifampin is recommended. However, there are no set guidelines defining optimal duration of therapy. Anecdotal evidences support extended doxycycline therapy for 3-6 months to prevent potential dissemination. CONCLUSIONS: Clinicians should suspect Bartonella endocarditis in patients with culture-negative endocarditis who have had extensive contact to cats. Reference #1: Chomel B et al: Fatal Case of Endocarditis Associated with Bartonella henselae Type I Infection in a Domestic Cat. Journal Of Clinical Microbiology; Nov. 2003, p. 5337-5339 Reference #2: Drancourt M et al: Bartonella (rochalimaea) quintana endocarditis in three homeless men. N Engl J Med 1995;332: 419-23 DISCLOSURE: The following authors have nothing to disclose: Thushara Paul, Siddhant Datta No Product/Research Disclosure Information

Glomérulonéphrite proliférative et érythroblastopénie associées à une endocardite à Bartonella quintana

Bartonella quintana is a facultative intracellular bacteria responsible of negative blood culture endocarditis whose diagnosis is often delayed. The occurrence of renal involvement has been exceptionally described in this context. We report the case of a 54-year-old man presenting with Bartonella quintana endocarditis complicated by proliferative glomerulonephritis with acute kidney injury and erythroblastopenia.

First Case ofBartonella quintanaEndocarditis in Korea

Since microbial gene sequencing was utilized for etiologic diagnosis of culture-negative endocarditis, cases of Bartonella endocarditis have been reported in various countries. Herein we report the first case of Bartonella quintana endocarditis, which was confirmed for the first time in Korea by 16S rRNA gene sequencing from the excised valve. A 75-yr-old woman was hospitalized due to dyspnea. Echocardiography demonstrated large oscillating vegetation at the aortic valve. Blood culture was negative. She underwent valve replacement and sequencing of the 16S rRNA gene from excised valve identified Bartonella quintana. She was successfully treated with combined use of ceftriaxone and gentamicin.

First known case of Bartonella quintana endocarditis in Sweden

In this report, we present the first known case of Bartonella endocarditis in Sweden. IgG antibody titres to Bartonella spp. were elevated but blood cultures remained negative. Sequencing of a gltA fragment from DNA extracted from heart valve tissue specimens revealed sequence homology with B. quintana.

Fatal myocarditis-associated Bartonella quintana endocarditis: a case report

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.

First Report of Bartonella Quintana Endocarditis in Japan

Bartonella (Rochalimaea) species are increasingly recognized as a cause of endocarditis, but the total number of cases remains low. Especially, Bartonella quintana endocarditis is very rare and there have been no reports in Japan. A 66-year-old man was hospitalized because of dyspnea and fever. An echocardiogram showed severe mitral valve regurgitation, mild aortic valve regurgitation, and echogenic masses on the mitral and aortic valve. Six sets of blood cultures were negative. Replacement of the mitral- and aortic-valve with a mechanical valve was performed. However, due to symptomatic para-valvular leakage a re-mitral valve replacement was later performed. Unfortunately, the patient died 1 month after the operation owing to multiple organ failure. Four weeks after the second operation, blood culture yielded a Gram-negative bacillus. DNA was extracted from the colony and subjected to polymerase chain reaction amplification. Nucleotide sequence analysis (1,500 nucleotide positions) and a BLAST search of the EMBL/GENBANK database revealed 99.9% homology with the Bartonella quintana 16S rRNA gene. This is the first report of Bartonella quintana endocarditis in Japan, and should be considered with the view of culture negative endocarditis.

A view on Bartonella quintana endocarditis—confirming the molecular diagnosis by specific fluorescence in situ hybridization

Culture-negative endocarditis is a frequent problem in cardiology, especially if caused by fastidious organisms. Among these, the diagnostic tools for the detection of Bartonella quintana are still unsatisfactory. In a culture-negative case of suspected endocarditis undergoing aortic valve replacement, polymerase chain reaction amplification and sequencing of the 16S rRNA gene indicated B. quintana infection. To develop a new diagnostic tool, independent from culture and amplification techniques, we designed and optimized an oligonucleotide fluorescence in situ hybridization (FISH) probe specific for B. quintana and suitable for FISH. FISH succeeded in simultaneous visualization and identification of vital microorganisms directly within the aortic valve tissue and in fast and univocal diagnosis of B. quintana endocarditis.

Transient monoclonal gammopathy in a patient withBartonella quintana endocarditis

Monoclonal gammopathy has been reported rarely in association with infectious diseases. Viral infection has been the most frequently reported. We report a case of Bartonella quintana endocarditis in a 45-year-old homeless male associated with a monoclonal IgG kappa gammopathy. The gammopathy disappeared after 8 months of antibiotics while the Bartonella antibody titre was decreasing. This correlation suggests a causative role for B. quintana for the monoclonal gammopathy. To the best of our knowledge, this the first report of monoclonal gammopathy in the course of B. quintana infection.

Bartonella quintana endocarditis with positive serology for Coxiella burnetii

Both Bartonella quintana and Coxiella burnetii are known to cause of blood culture negative endocarditis. In such case, the diagnosis is usually established by serology. A case of Bartonella quintana endocarditis is described where the serology was falsely positive for Coxiella burnetii. This case demonstrates the difficulty in distinguishing these two etiologic agents by routine serologic testing.

HIGH PREVALENCE OF BARTONELLA QUINTANA ENDOCARDITIS IN SFAX, TUNISIA

Bartonella quintana is a fastidious microorganism associated with blood culture negative endocarditis. In this study, 40 sera with cross-reactivity between Chlamydia species from patients from Sfax, Tunisia, were serologically tested for Bartonella. Thirteen sera were positive for Bartonella with IgG titers >/=1:800. Western blot and cross-absorption confirmed the diagnosis of Bartonella quintana endocarditis in 12 cases and Bartonella henselae endocarditis in 1 case. These sera were also positive by LightCycler nested PCR amplification for the rnpb (7 of 13) and fur (11 of 13) genes. Eleven patients had a definite diagnosis of endocarditis, which represents 9.8% of all endocarditis. Because Bartonella endocarditis seems to be very common in Tunisia, we suggest that its serology be performed systematically whenever endocarditis is suspected.

Bartonella-like erythrocyte inclusions in thrombotic thrombocytopenic purpura

Bartonella species have been associated with cat-scratch disease, bacillary angiomatosis, peliosis hepatitis, and meningioencephalitis. Initial attempts to culture the causative organism were unsuccessful. Culture-negative endocarditis, is now believed to be caused by B henselae or B quintana. 1 Drancourt M Birtles R Chaumentin G Vandendenesch F Etienne J Raoult D A new serotype of Bartonella henselae endocarditis and cat-scratch disease. Lancet. 1996; 347: 441-534 Summary Full Text PDF PubMed Scopus (178) Google Scholar , 2 Drancourt M Mainardi JL Brouqui P et al. Bartonella (Rochalimaea) quintana endocarditis in three homeless men. N Engl J Med. 1995; 332: 419-423 Crossref PubMed Scopus (320) Google Scholar We have observed rod-shaped structures resembling bacteria on red blood cells (RBCs) of patients with thrombotic thrombocytopenic purpura (TTP). TTP is characterised by consumptive thrombocytopenia, microangiopathic haemolytic anaemia, fever, fluctuating neurological symptoms, and progressive renal failure. 3 Rock GA Shumak KH Buskard NA et al. Comparison of plasma exchange with plasma infusion in the treatment of thrombotic thrombocytopenic purpura. Canadian Apheresis Study Group. N Engl J Med. 1991; 325: 393-397 Crossref PubMed Scopus (1507) Google Scholar