Bartonella, a Common Cause of Endocarditis: a Report on 106 Cases and Review

Edouard, Sophie; Nabet, Cécile; Lépidi, Hubert; Fournier, Pierre‐Edouard; Raoult, Didier

doi:10.1128/jcm.02827-14

Cited by 122 publications

(217 citation statements)

References 35 publications

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“…Due to the relative abundance of bacterial DNA in valve tissue versus blood, testing of cardiac valve tissue with organism-specific PCR assays is more sensitive than testing blood or serum. For example, in one study, sensitivity of a Bartonella PCR assay on valve tissue was 92% (48/52) compared to 33% (20/60) and 36% (25/70) sensitivity in blood and serum, respectively (26). Nevertheless, a PCR result on blood may be helpful when positive.…”

Section: Evaluation Of Excised Cardiac Valvular Tissuementioning

confidence: 99%

“…In cases where both broad-range bacterial PCR and organism-specific PCR were performed for the diagnosis of endocarditis, 62% (76/123) of specimens were positive by targeted PCR only, while only 2 specimens were positive by broad-range PCR only (34). For the diagnosis of Bartonella endocarditis, Bartonella-specific PCR applied to cardiac valve tissue was positive in 92% (48/52) of cases while broad-range PCR of valve tissue identified Bartonella in only 60% (21/35) of cases (26). Therefore, for diagnosis of culture-negative endocarditis, broad-range bacterial PCR should not be performed in lieu of organism-specific PCR.…”

Section: Evaluation Of Excised Cardiac Valvular Tissuementioning

confidence: 99%

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Laboratory Diagnosis of Infective Endocarditis

et al. 2017

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Infective endocarditis is life-threatening; identification of the underlying etiology informs optimized individual patient management. Changing epidemiology, advances in blood culture techniques, and new diagnostics guide the application of laboratory testing for diagnosis of endocarditis. Blood cultures remain the standard test for microbial diagnosis, with directed serological testing (i.e., Q fever serology, Bartonella serology) in culture-negative cases. Histopathology and molecular diagnostics (e.g., 16S rRNA gene PCR/sequencing, Tropheryma whipplei PCR) may be applied to resected valves to aid in diagnosis. Herein, we summarize recent knowledge in this area and propose a microbiologic and pathological algorithm for endocarditis diagnosis. KEYWORDS clinical microbiology, endocarditisD espite recent advances in diagnostic and therapeutic strategies, the mortality of infective endocarditis remains high, with more than one-third of patients affected dying within a year following diagnosis (1, 2). Identification of the specific underlying microbial etiology is essential for optimal patient management; delays in microbial diagnosis may contribute to late initiation of effective antimicrobial therapy, influencing morbidity and mortality. The modified Duke criteria provide a basic scheme for diagnosis and definition of endocarditis and rely on detection of infecting microorganisms in addition to echocardiographic and clinical findings (1, 3). The finding of two (or more) blood cultures positive for a typical microorganism consistent with infective endocarditis is a major criterion for infective endocarditis as is positive Q fever serology (anti-phase I IgG titer of Ն1:800). Echocardiographic findings are also considered but are beyond the scope of the manuscript.The epidemiology of endocarditis, which has shifted in recent years, should guide diagnostic testing. Today, staphylococci and streptococci combined cause ϳ80% of cases. Staphylococcus aureus remains the dominant pathogen, associated with ϳ25% to ϳ30% of cases, while coagulase-negative staphylococci account for ϳ11% of cases (4, 5). Streptococci, primarily viridans group streptococci, cause ϳ30% of cases, with Streptococcus gallolyticus (a Streptococcus bovis group member) being involved in ϳ20% to ϳ50% of streptococcal cases (4, 5). Enterococci, especially Enterococcus faecalis, account for ϳ10% of cases (4, 5). Gram-negative bacilli account for ϳ5% of cases and include the HACEK group organisms (Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, and Kingella species) and, less commonly, non-HACEK Gramnegative bacilli, such as the Enterobacteriaceae and nonfermenting Gram-negative bacilli. Fungi are rare endocarditis causes, with Candida species being the most common. A number of uncultivable or challenging to cultivate organisms cause endocarditis, the most common of which are Coxiella burnetii, Bartonella species, and Tropheryma whipplei.Endocarditis most often involves the aortic or mitral valves, with tricuspid valve involvement accoun...

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Section: Evaluation Of Excised Cardiac Valvular Tissuementioning

confidence: 99%

Section: Evaluation Of Excised Cardiac Valvular Tissuementioning

confidence: 99%

Laboratory Diagnosis of Infective Endocarditis

et al. 2017

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“…1,2,5 Congenital heart disease and prosthetic valve repair have been identified as risk factors for the development of B. henselae endocarditis, particularly in the pediatric population. 4,7 Serology, polymerase chain reaction, or histology is needed to identify Bartonella spp., when suspected. 2 IE may present with renal comorbidities such as perinephric abscesses, infarction from emboli, or glomerulonephritis.…”

Section: Discussionmentioning

confidence: 99%

“…2 Bartonella henselae usually affects patients with previous valvular disease, prosthetic or bioprosthetic valves, or congenital heart defects. 3,4 In rare instances, patients with Bartonella endocarditis may develop glomerulonephritis. 5,6 …”

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confidence: 99%

Bartonella endocarditis with glomerulonephritis in a patient with complete transposition of the great arteries

Hashemi

Endicott-Yazdani

Oguayo

et al. 2018

Baylor University Medical Center Proceedings

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We describe a patient with history of dextro-transposition of the great vessels, ventricular septal defect, and pulmonary valve replacement who presented with fatigue, prolonged fever, and leg edema. He was found to have kidney injury, pancytopenia, and liver congestion. Echocardiogram revealed thickened leaflets with prolapsing vegetation on the pulmonary valve. Given the negative blood cultures, high Bartonella henselae immunogobulin G titer (1:1024) and positive immunoglobulin M titer (1:20), he was diagnosed with Bartonella endocarditis complicated with glomerulonephritis.KEYWORDS Bartonella henselae; culture-negative endocarditis; glomerulonephritis; prosthetic valve B artonella species are rare causes of infective endocarditis (IE).1,2 Patients with Bartonella endocarditis usually present with signs and symptoms of IE, but blood cultures are usually negative.2 Bartonella henselae usually affects patients with previous valvular disease, prosthetic or bioprosthetic valves, or congenital heart defects. 3,4 In rare instances, patients with Bartonella endocarditis may develop glomerulonephritis. 5,6 CASE DESCRIPTIONA 29-year-old man had complete transposition of the great arteries and ventricular septal defect, for which he received Rastelli repair at age 4 and right ventricle-to-pulmonary artery conduit replacement with a porcine valve at age 18 for conduit stenosis. He initially presented with fatigue, prolonged fever, and leg edema. His temperature was 101 F. A 5/6 harsh systolic murmur was heard over the left sternal border, his jugular veins were distended, his liver was enlarged, and his ankles were edematous. His erythrocyte sedimentation rate was 58 (normal range 0-15 mm/hr), C-reactive protein was 5.1 (normal range 0.0-0.3 mg/dL), creatinine was 3.3 mg/dL, red blood cells were 2.83 M/mL, white blood cells were 3.2 K/mL, and platelets were 105 K/mL. Echocardiogram showed a left ventricular ejection fraction of 35% to 40%. The pulmonic valve had thickened cusps and a prolapsing mass. He was treated with vancomycin, doxycycline, and piperacillin/tazobactam.The blood cultures, drawn at the time of presentation, showed no growth. The urine protein-creatinine ratio was 4.4 and his 24-hour urine protein was 6.4 g. C3 was 61.4 mg/dL (normal range 90-180 mg/dL), complement C4 was 9.4 mg/dL (normal range 10-40 mg/dL), and serum albumin was 2.3 g/ dL. Antineutrophil cytoplasmic antibody in the serum was positive. A kidney biopsy revealed focal segmental proliferative glomerulonephritis with incomplete crescent formation. Electron microscopy showed small mesangial electron-dense deposits and widespread foot process effacement. The mesangial regions were positive for the following immunofluorescence markers: immunoglobulin G (IgG), immunoglobulin M (IgM), C3, C1q, and kappa and lambda light chains. Though not specific, IgM immunofluorescence demonstrated the brightest signal, suggestive of a recent or ongoing infection (Figure 1).Brucella antibody, Coxiella burnetii IgG and IgM, and Ehrlichia IgG were negat...

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“…or Coxiella burnetii. However, Edouard et al showed that an IgG titer greater than 1:800 (in an immunofluorescence antibody assay) or a positive western blot can be considered as major Duke criteria indicating Bartonella endocarditis [14].…”

Section: Discussionmentioning

confidence: 99%

C-ANCA-positive glomerulonephritis associated with subacute infective endocarditis caused by Bartonella infection

Kim

Jang

Lee

et al. 2017

Yeungnam Univ J Med

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Glomerulonephritis (GN) is sometimes associated with infective endocarditis (IE). Bartonella endocarditis is difficult to diagnose because it is rare and cannot be detected by blood culture. This is the first report of cytoplasmic anti-neutrophil cytoplasmic antibody-positive subacute endocarditis-associated GN caused by Bartonella infection in South Korea. A 67-year-old man was hospitalized due to azotemia. He complained of weight loss and anorexia for 6 months. A diagnosis of IE was made based upon echocardiographic detection of vegetations on the mitral and aortic valves and a Bartonella antibody titer of 1:2,048. Renal histology identified focal crescentic GN. Azotemia and proteinuria improved after doxycycline and rifampin treatment combining with steroid therapy.

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Bartonella, a Common Cause of Endocarditis: a Report on 106 Cases and Review

Cited by 122 publications

References 35 publications

Laboratory Diagnosis of Infective Endocarditis

Laboratory Diagnosis of Infective Endocarditis

Bartonella endocarditis with glomerulonephritis in a patient with complete transposition of the great arteries

C-ANCA-positive glomerulonephritis associated with subacute infective endocarditis caused by Bartonella infection

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