Infective Endocarditis due to Bartonella spp. and Coxiella burnetii

Abstract

Bartonella spp. and Coxiella burnetii are recognized as causative agents of blood culture-negative endocarditis (BCNE) in humans and there are no studies of their occurrences in Brazil. The purpose of this study is to investigate Bartonella spp. and C. burnetii as a causative agent of culture-negative endocarditis patients at a cardiology hospital in São Paulo, Brazil. From January 2004 to December 2004 patients with a diagnosis of endocarditis at our Institute were identified and recorded prospectively. They were considered to have possible or definite endocarditis according to the modified Duke criteria. Those with blood culture-negative were tested serologically using the indirect immunofluorescent assay (IFA) for Bartonella henselae, B. quintana, and C. burnetii. IFA-IgG titers >800 for Bartonella spp. and C. burnetii were considered positive. A total of 61 patients with endocarditis diagnosis were evaluated, 17 (27%) were culture-negative. Two have had IgG titer greater than 800 (>/=3,200) against Bartonella spp. and one against C. burnetii (phase I and II>/=6,400). Those with Bartonella-induced endocarditis had a fatal disease. Necropsy showed calcifications and extensive destruction of the valve tissue, which is diffusely infiltrated with mononuclear inflammatory cells predominantly by foamy macrophages. The patient with C. burnetii endocarditis received specific antibiotic therapy. Reports of infective endocartitis due to Bartonella spp. and C. burnetii in Brazil reveal the importance of investigating the infectious agents in culture-negative endocarditis.

Human bartonellosis: seroepidemiological and clinical features with an emphasis on data from Brazil - A review

“…The diagnosis was made retrospectively based on very high IgG titers (1:4096) to B. henselae in serum collected prior to antibiotic therapy, and lower levels (1:512) 14 months after completion of specific treatment. Two possible cases of IE have also been reported by Siciliano et al (2006) in Brazil. One patient had native aortic valve IE and the other a prosthetic aortic valve IE, and both had domestic cats.…”

Molecular characterisation of Bartonella species in cats from São Luís, state of Maranhão, north-eastern Brazil

“…In this study, contact with cats was identified as a risk factor for Bartonella exposure. Clinical cases associated with high IgG titres against Bartonella spp have been reported in Brazil, including two fatal cases of culture-negative endocarditis (Siciliano et al 2006) and one asymptomatic case (Lamas et al 2007). Additionally, a 40-year-old man tested seropositive for Bartonella spp, likely from a cat scratch, which was complicated with aseptic meningitis and neuroretinitis (Pinto Júnior et al 2008).…”

Canine bartonellosis: serological and molecular prevalence in Brazil and evidence of co-infection withBartonella henselaeandBartonella vinsoniisubsp.berkhoffii

“…With the notable exception of B. bacilliformis, there are only a limited number of reports describing human infection with other Bartonella species in South America. In Brazil, B. quintana was detected by PCR in an infant [3] and two fatal cases of endocarditis were associated with high B. henselae antibody titers [41]. In contrast to humans, B. henselae seroreactivity was reported in 46% of 102 cats 2 suggesting that exposure to this organism in Brazil may be 1 Henn J.B., Koehler J.E., Gabriel M., Kasten R.W., Brown R.N., Papageorgiou S., Chomel B.B., Zoonotic Bartonella spp.…”