Bartonella (Rochalimaea) Species as a Cause of Apparent "Culture-Negative" Endocarditis

Abstract

Bartonella quintana (formerly Rochalimaea quintana) is a recently recognized cause of apparent "culture-negative" endocarditis. We describe a 39-year-old, homeless man who developed aortic valve endocarditis caused by B. quintana. He had a history of alcoholism and was seronegative for the human immunodeficiency virus. We established that B. quintana was the cause of the endocarditis on the basis of the isolation of B. quintana from blood cultures, the compatibility of histochemical stains of cardiac valve tissue, the reactivity of the polymerase chain reaction specific for B. quintana on cardiac valve tissue, and the failure to isolate an alternative causative organism despite extensive efforts. This is the second report of endocarditis caused by B. quintana and the fourth report of endocarditis caused by a Bartonella species. On the basis of the findings of this report and those of other recent reports, further study is warranted to determine the overall role of Bartonella species in apparent culture-negative endocarditis.

Diagnosis and Management of Infective Endocarditis and Its Complications

“…To recover the HACEK organisms, prolonged incubation and subcultures as noted above may be required. Bartonella species, recently recognized as an important cause of apparent culture-negative IE, can also be isolated by prolonged incubation and subculture of the aerobic broth media [44][45][46][47][48][49] ; subculture on endothelial cell tissue culture may be required in some instances. 48 The nutritionally variant streptococci (now classified as Abiotrophia species) account for Ϸ5% to 7% of streptococcal IE cases.…”

Multispacer Typing Technique for Sequence-Based Typing ofBartonella quintana

“…It was described as a relapsing fever or quintan fever characterized by attacks of fever associated with headaches, skin pain, and dizziness, recurring every 4 to 6 days (24). B. quintana is also known to be responsible for endocarditis (9,15,34,42,43) and bacillary angiomatosis, which occur in both human immunodeficiency virus-infected and immunocompetent patients (23,29,36,37).More recently, chronic asymptomatic bacteremias and relapsing febrile illness have been reported in homeless populations (5,13,32,44,45). Up to 14% of bacteremic subjects have been retrieved among homeless people tested in the university hospital in Marseilles, France (5), suggesting an epidemic in this population.…”

“…It was described as a relapsing fever or quintan fever characterized by attacks of fever associated with headaches, skin pain, and dizziness, recurring every 4 to 6 days (24). B. quintana is also known to be responsible for endocarditis (9,15,34,42,43) and bacillary angiomatosis, which occur in both human immunodeficiency virus-infected and immunocompetent patients (23,29,36,37).…”

Native Valve Endocarditis Due to Bartonella henselae in a Middle-Aged Human Immunodeficiency Virus-Negative Woman

“…Bartonella was first described as a cause of endocarditis in two separate reports in 1993 (7,16). More recently, it has been recognized as an important cause of culture-negative endocarditis (4,14,17). Three Bartonella species, in particular, are known to cause infective endocarditis: B. henselae, B. quintana, and B. elizabethae.…”

“…First, the role of antibiotic therapy is limited by the fact that most Bartonella endocarditis patients have undergone valve replacement despite intravenous antimicrobial therapy (8,14,17). Second, the literature consists mostly of series of case reports and does not show use of a consistent antibiotic therapy regimen.…”