PCR was used to detect Coxiella burnetii and Bartonella spp in heart valves obtained during the period 1998-2009 from patients operated on for blood culture-negative endocarditis in a cardiac surgery hospital in Brazil. Of the 51 valves tested, 10 were PCR-positive; two were positive for Bartonella and one for C. burnetii.

Bartonella is an important cause of blood culture-negative endocarditis in recent studies. Seroprevalence studies in the States of Minas Gerais and Rio de Janeiro have shown Bartonella IgG positivity around 14% in healthy adults and 40% in HIV seropositive adults, respectively. A case report of a 46-year-old white male with moderate aortic regurgitation (AR) due to rheumatic heart disease (RHD), admitted due to worsening heart failure, is presented. Clinical features were apyrexia, anemia, polyclonal hypergammaglobulinemia, hematuria and splenomegaly. He was submitted to surgery due to worsening AR. Histopathology of the excised valve showed active bacterial endocarditis and underlying RHD. Routine blood cultures were negative. Indirect immunofluorescence (IFI) assays for Coxiella burnetii were non-reactive. Bartonella henselae IgG titer was 1:4096 prior to antibiotics and 1:512 14 months after treatment. History of close contact with a young cat during the months preceding his admission was elicited. Key-Words: Bartonella spp., infective endocarditis, blood culture-negative infective endocarditis, rheumatic heart disease, serology, indirect immunofluorescence.Bartonella endocarditis has been recognized since the first reports from the 1990's [1-8] and its importance in blood culture-negative infective endocarditis (IE) has been reinforced in recent studies [9][10][11][12][13][14]. Although there are three national rickettsial diseases reference laboratories in Brazil (FIOCRUZ, Rio de Janeiro, Adolpho Lutz, in São Paulo, and FUNEDE, in Minas Gerais), only two probable fatal cases of Bartonella endocarditis have been reported so far in our country [14]. There are also case reports of Bartonella disease such as bacillary angiomatosis in HIV-positive individuals, disseminated disease in children and cat-scratch disease in Brazil, and there are also groups who work experimentally with Bartonella [15][16][17][18][19][20][21]. Two seroprevalence studies, one in the State of Minas Gerais [22], and the other in the city of Rio de Janeiro [23], show that the Brazilian population is significantly exposed to Bartonella. We present the first case of Bartonella endocarditis from Brazil, whose diagnosis was done ante-mortem and who had an extremely favourable outcome. Case ReportA 46-year-old white male patient was admitted to Instituto Nacional de Cardiologia (INC), Rio de Janeiro, due to worsening heart failure in October 2005. He was born and resided in São Gonçalo, a town situated one hour from Rio de Janeiro. He became ill in 1994, during his job as a security officer. Essential hypertension was diagnosed then, as well as valvular disease. He was followed up in INC outpatient clinic. His first transthoracic echocardiography (TTE) in 1995 showed moderate aortic regurgitation and a calcified aortic valve. He retired a few years later due to heart failure. He was a poor historian, but his present admission was due to progression of fatigue and dyspnea on minimal exertion over the past four months. He denied fever. He was on...

BackgroundHealthcare-associated infective endocarditis (HCA-IE), a severe complication of medical care, shows a growing incidence in literature.ObjectiveTo evaluate epidemiology, etiology, risk factors for acquisition, complications, surgical treatment, and outcome of HCA-IE.MethodsObservational prospective case series study (2006-2011) in a public hospital in Rio de Janeiro.ResultsFifty-three patients with HCA-IE from a total of 151 cases of infective endocarditis (IE) were included. There were 26 (49%) males (mean age of 47 ± 18.7 years), 27 (51%) females (mean age of 42 ± 20.1 years). IE was acute in 37 (70%) cases and subacute in 16 (30%) cases. The mitral valve was affected in 19 (36%) patients and the aortic valve in 12 (36%); prosthetic valves were affected in 23 (43%) patients and native valves in 30 (57%). Deep intravenous access was used in 43 (81%) cases. Negative blood cultures were observed in 11 (21%) patients, Enterococcus faecalis in 10 (19%), Staphylococcus aureus in 9 (17%), and Candida sp. in 7 (13%). Fever was present in 49 (92%) patients, splenomegaly in 12 (23%), new regurgitation murmur in 31 (58%), and elevated C-reactive protein in 44/53 (83%). Echocardiograms showed major criteria in 46 (87%) patients, and 34 (64%) patients were submitted to cardiac surgery. Overall mortality was 17/53 (32%).ConclusionIn Brazil HCA-IE affected young subjects. Patients with prosthetic and native valves were affected in a similar proportion, and non-cardiac surgery was an infrequent predisposing factor, whereas intravenous access was a common one. S. aureus was significantly frequent in native valve HCA-IE, and overall mortality was high.

Despite cardiac metastases are found in about 20% of cancer deaths, the presence of primary cardiac tumors is rare. Most primary tumors are benign, and malignant tumors comprise about 15%. We report a 21-year-old man with fever, dyspnea, and hemoptysis that was diagnosed with angiosarcoma of the right atrium and pulmonary metastasis. Patient was submitted to surgical tumor resection without adjuvant therapy and died four months after diagnosis.

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