Bartonella quintana Endocarditis of the Tricuspid and Mitral Valves

Alozie, Anthony; Yerebakan, Can; Westphal, Bernd; Podbielski, Andreas

doi:10.1055/s-0030-1270994

Thorac cardiovasc Surg

2011

DOI: 10.1055/s-0030-1270994

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Bartonella quintana Endocarditis of the Tricuspid and Mitral Valves

Anthony Alozie

Can Yerebakan²,

Bernd Westphal³

et al.

Abstract: Bartonella quintana is a gram-negative microorganism that can lead to culture-negative infective endocarditis (IE) in immunocompromised patients. Here, we present an exceptionally rare case of a 70-year-old male with Bartonella quintana-associated IE primarily limited to the tricuspid valve that spread to the mitral valve after tricuspid valve replacement. This was then complicated by infective spondylodiscitis of the thoracic vertebrae, ultimately resulting in death due to cardiac arrest.

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2023

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Cited by 2 publications

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Bartonella quintana Endocarditis: A Systematic Review of Individual Cases

Boodman,

Gupta,

Nelson

et al. 2023

Clinical Infectious Diseases

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Introduction Bartonella quintana is a louse-borne bacterium that remains a neglected cause of endocarditis in low-resource settings. Our understanding of risk factors, clinical manifestations and treatment of B. quintana endocarditis are biased by older studies from high-income countries. Methods We searched Pubmed Central, Medline, Scopus, Embase, EBSCO (CABI) Global Health, Web of Science and international trial registers for articles published before March 2023 with terms related to Bartonella quintana endocarditis. We included articles containing case-level information on B. quintana endocarditis and extracted data related to patient demographics, clinical features, diagnostic testing, treatment and outcome. Results A total of 975 records were identified, of which 569 duplicates were removed prior to screening. 84 articles were eligible for inclusion, describing a total of 167 cases. Infections were acquired in 40 different countries. 62 cases (37.1%) were acquired in low and middle-income countries (LMICs). Disproportionately more female and pediatric patients were from LMICs. More patients presented with heart failure (n = 70/167 [41.9%]) than fever (n = 65/167 [38.9%]). Mean time from symptom onset to presentation was 5.1 months. 25.7% of cases (n = 43/167) were associated with embolization, most commonly to the spleen and brain. 65.5% of antimicrobial regimens included doxycycline. The vast majority of cases underwent valve replacement surgery (n = 154/167, [98.0%]). Overall case fatality rate was 9.6% (n = 16/167). Conclusion B. quintana endocarditis has a global distribution, and long delays between symptom onset and presentation frequently occur. Improved clinician education and diagnostic capacity are needed to screen at-risk populations and identify infection before endocarditis develops.

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Bartonella quintana Endocarditis: A Systematic Review of Individual Cases

Boodman,

Gupta,

Nelson

et al. 2023

Clinical Infectious Diseases

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

Sarsiat,

Garrigos,

Houhamdi

et al. 2023

PLoS Negl Trop Dis

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Background 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). Method 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. Findings 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. Conclusions 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.

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Bartonella quintana Endocarditis of the Tricuspid and Mitral Valves

Cited by 2 publications

References 10 publications

Bartonella quintana Endocarditis: A Systematic Review of Individual Cases

Bartonella quintana Endocarditis: A Systematic Review of Individual Cases

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

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