Culture-Negative Endocarditis Probably Due to Chlamydia pneumoniae

Tj, Marrie; Harczy, M; Oe, Mann; Rw, Landymore; Raza, Adil; Sp, Wang; Jt, Grayston

doi:10.1093/infdis/161.1.127

Cited by 61 publications

(22 citation statements)

References 12 publications

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“…Declining C. pneumoniae IgM titers during the observation period suggested primary infection. Our findings were in accordance with those of Marrie et al (13). Their patient had also shown declining IgM titers, whereas the patients described by other investigators had no IgM response, suggesting reinfection (4,15,16).…”

Section: Case Reportsupporting

confidence: 93%

“…Its role in endocarditis remains little documented. Among the approximately 20 published reports of Chlamydia endocarditis, C. psittaci was considered the etiologic agent in 11 reports, C. trachomatis was considered the etiologic agent in 2 reports, and C. pneumoniae was considered the etiologic agent in the remaining ones (4,6,10,13,14). In most of the cases, diagnosis was established solely by serology.…”

Section: Case Reportmentioning

confidence: 99%

“…The demonstration of a cross-reaction between bacterial species has raised the possibility of misdiagnosis. Maurin et al (14) demonstrated that the serological diagnosis of C. pneumoniae endocarditis was erroneous in at least two reports (6,13) and that most of the patients were probably suffering from Bartonellainduced endocarditis rather than Chlamydia-induced endocarditis. In some cases, in addition to serology, the diagnosis was made on the basis of electron microscopy and/or immunofluorescence performed with cardiac valve tissue specimens.…”

Section: Case Reportmentioning

confidence: 99%

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Culture-Negative Endocarditis Due to Chlamydia pneumoniae

Gdoura¹,

Pereyre

Frikha³

et al. 2002

J Clin Microbiol

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We report on the case of a 54-year-old woman diagnosed as having culture-negative endocarditis (clinical and histopathologic evidence compatible with a recent episode of endocarditis). The responsibility of Chlamydia pneumoniae in this episode of endocarditis was suggested by a serological study and was then confirmed by the positive results of PCR and in situ hybridization tests with aortic and mitral valves tissues. To our knowledge, this is the first case of endocarditis due to C. pneumoniae confirmed by molecular biology-based techniques. CASE REPORTOn 30 April 1998, a 54-year-old woman was admitted to the Department of Cardiology, Sfax Hospital, Sfax, Tunisia, because of suspicion of infectious endocarditis. Fifteen days before admission she had noted fever and progressively increasing dyspnea. She had no significant medical history, and she did not have any cats or birds.On physical examination, her blood pressure was 110/40 mm Hg, her pulse was 72 beats/min, and her axillary temperature was 39°C. Cardiac auscultation revealed systolic mitral and diastolic aortic murmurs. In addition, the liver and spleen showed hypertrophy. The rest of the physical examination was normal.An electrocardiogram showed a diastolic hypertrophy of the left ventricle. A chest radiograph was normal. An echocardiographic examination confirmed the mitral and aortic insufficiency but did not show any vegetations. Transesophageal echocardiography revealed severe aortic and mitral valve regurgitation, a vegetation (7 by 6 mm) on the right of the aortic valve, and a vegetation (5 by 6 mm) on the mitral valve.After this examination a diagnosis of endocarditis was strongly suspected. The white blood cell count was 3.6 ϫ 10 9 / liter, the hemoglobin concentration was 7 g/100 ml, and the erythrocyte sedimentation rate was 75 mm/h (normal rate, Ͻ10 mm/h). Three pairs of aerobic and anaerobic blood specimens for culture (Hemoline; bioMerieux, Marcy l'Etoile, France) drawn before administration of penicillin and gentamicin remained negative. Blood cultures were incubated at 37°C for a total of 15 days, examined daily, and subcultured on conventional media at 5, 10, and 15 days. Serum samples obtained on admission and 2 and 4 weeks later showed negative results when tested for antibodies to the following agents: Legionella pneumophila, Mycoplasma pneumoniae, and Coxiella burnetii. However, the concentration of immunoglobulin G (IgG) antibodies to C. pneumoniae, as determined by microimmunofluorescence (MIF) assay, was higher than 1:4,096 for all three serum samples. There were also cross-reactions with antigens of Chlamydia trachomatis and Chlamydia psittaci in the three serum samples. All three serum samples were positive for IgM antibodies to C. pneumoniae by the MIF test. A specific IgG antibody response for C. pneumoniae and declining C. pneumoniae IgM titers during the observation period were detected by a commercial enzyme-linked immunosorbent assay (ELISA) with C. pneumoniae (Sero CP;

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Section: Case Reportsupporting

confidence: 93%

Section: Case Reportmentioning

confidence: 99%

Section: Case Reportmentioning

confidence: 99%

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Culture-Negative Endocarditis Due to Chlamydia pneumoniae

Gdoura¹,

Pereyre

Frikha³

et al. 2002

J Clin Microbiol

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“…However, in a recent review of 10 patients reported to have chlamydial endocarditis, 8 were finally diagnosed with Bartonella endocarditis after their sera were tested by antibody cross-absorption and Western immunobloting (176,225). Interestingly, epidemiologic data for three of these eight patients were comparable to those reported for Bartonella endocarditis patients, including homelessness and alcoholism (172,176). Therefore, by using serologic testing only, it is difficult to know how many patients really have chlamydial endocarditis.…”

Section: ͻ150 ϫ 10mentioning

confidence: 93%

“…The reservoir of B. henselae is the cat, which is chronically bacteremic, and humans are likely to be the reservoir of B. quintana. Review of the literature and personal unpublished observations found a total of 54 cases of Bartonella endocarditis, 8 of which were caused by B. henselae (10,63,112,126,225), 20 were caused by B. quintana (30,65,131,168,225,257,258), 1 was caused by B. elizabethae (51), one was caused by B. vinsonii (239), and 20 were not characterized at the species level since they were diagnosed by serologic testing alone (75,172,225; unpublished data). Bartonella infection was diagnosed in 3 of 86 patients with endocarditis in Marseilles (3.5%), 3 of 123 patients with endocarditis in Halifax (2.4%), and 4 of 90 patients in Lyons (4.4%) (225).…”

Section: Agents Of Blood Culture-negative Endocarditismentioning

confidence: 99%

Endocarditis Due to Rare and Fastidious Bacteria

2001

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The etiologic diagnosis of infective endocarditis is easily made in the presence of continuous bacteremia with gram-positive cocci. However, the blood culture may contain a bacterium rarely associated with endocarditis, such as Lactobacillus spp., Klebsiella spp., or nontoxigenic Corynebacterium, Salmonella, Gemella, Campylobacter, Aeromonas, Yersinia, Nocardia, Pasteurella, Listeria, or Erysipelothrix spp., that requires further investigation to establish the relationship with endocarditis, or the blood culture may be uninformative despite a supportive clinical evaluation. In the latter case, the etiologic agents are either fastidious extracellular or intracellular bacteria. Fastidious extracellular bacteria such as Abiotrophia, HACEK group bacteria, Clostridium, Brucella, Legionella, Mycobacterium, and Bartonella spp. need supplemented media, prolonged incubation time, and special culture conditions. Intracellular bacteria such as Coxiella burnetii cannot be isolated routinely. The two most prevalent etiologic agents of culture-negative endocarditis are C. burnetti and Bartonella spp. Their diagnosis is usually carried out serologically. A systemic pathologic examination of excised heart valves including periodic acid-Schiff (PAS) staining and molecular methods has allowed the identification of Whipple's bacillus endocarditis. Pathologic examination of the valve using special staining, such as Warthin-Starry, Gimenez, and PAS, and broad-spectrum PCR should be performed systematically when no etiologic diagnosis is evident through routine laboratory evaluation

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Bloodstream Infection and Endocarditis

Seifert

Wisplinghoff

2010

Topley &Amp; Wilson's Microbiology and Microbial Infections

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Culture-Negative Endocarditis Probably Due to Chlamydia pneumoniae

Cited by 61 publications

References 12 publications

Culture-Negative Endocarditis Due to Chlamydia pneumoniae

Culture-Negative Endocarditis Due to Chlamydia pneumoniae

Endocarditis Due to Rare and Fastidious Bacteria

Bloodstream Infection and Endocarditis

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