Bartonella Endocarditis in Spain: Case Reports of 21 Cases

Abstract

Blood culture negative endocarditis (BCNE) is frequent in infective endocarditis (IE). One of the causes of BCNE is fastidious microorganisms, such as Bartonella spp. The aim of this study was to describe the epidemiologic, clinical characteristics, management and outcomes of patients with Bartonella IE from the “Spanish Collaboration on Endocarditis-Grupo de Apoyo al Manejo de la Endocarditis infecciosa en España (GAMES)”cohort. Here we presented 21 cases of Bartonella IE. This represents 0.3% of a total of 5590 cases and 2% of the BCNE from the GAMES cohort. 62% were due to Bartonella henselae and 38% to Bartonella quintana. Cardiac failure was the main presenting form (61.5% in B. hensalae, 87.5% in B. quintana IE) and the aortic valve was affected in 85% of the cases (76% in B. henselae, 100% in B. quintana IE). Typical signs such as fever were recorded in less than 40% of patients. Echocardiography showed vegetations in 92% and 100% of the patients with B. henselae and B. quintana, respectively. Culture was positive only in one patient and the remaining were diagnosed by serology and PCR. PCR was the most useful tool allowing for diagnosis in 16 patients (100% of the studied valves). Serology, at titers recommended by guidelines, only coincided with PCR in 52.4%. Antimicrobial therapy, in different combinations, was used in all cases. Surgery was performed in 76% of the patients. No in-hospital mortality was observed. One-year mortality was 9.4%. This article remarks the importance for investigating the presence of Bartonella infection as causative agent in all BCNE since the diagnosis needs specific microbiological tools and patients could benefit of a specific treatment.

Cat Scratch Endocarditis

“…Our case stands as one of the few cases of B. henselae endocarditis described in Italy. 8 Its clinical presentation aligns with previous data, 9 with diagnostic suspicion guided by known cat exposure. In this case, IE was associated with myocardial infarction (MI) with nonobstructive coronary arteries, supported by elevated troponin, wall motion abnormalities, and open coronary arteries on cardiac CT. A type 2 MI caused by coronary emboli was hypothesized, given the documented systemic embolization.…”

The Role of Platelets in Infective Endocarditis

“…or may be of appreciable size, as in the case of T. whipplei and Bartonella endocarditis [38][39][40][41]. Intuitively, we tend to think that no platelet-bacterium interaction can be initiated when the two cells are present in different environments.…”

“…IE can be caused by intracellular bacteria, such as Coxiella burnetii and Tropheryma whipplei, as well as facultative intracellular bacteria, such as the Bartonella genus. In these cases of IE, vegetation may be poorly developed, as in the case of C. burnetii endocarditis, or may be of appreciable size, as in the case of T. whipplei and Bartonella endocarditis [38][39][40][41]. Intuitively, we tend to think that no platelet-bacterium interaction can be initiated when the two cells are present in different environments.…”

Bartonella- and Borrelia-Related Disease Presenting as a Neurological Condition Revealing the Need for Better Diagnostics

“…However, 45 different species of Bartonella have been identified so far [ 3 ]. Bartonella has been found in blood-culture-negative endocarditis patients, more than 60% of whom presented without a fever [ 3 , 4 ]. Patients infected with Bartonella spp.…”