Laboratory Approach to the Diagnosis of Culture-Negative Infective Endocarditis

Subedi, Shradha; Jennings, Zoe; Chen, S.C.-A.

doi:10.1016/j.hlc.2017.02.009

Cited by 44 publications

(45 citation statements)

References 64 publications

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“…henselae and B. quintana, respectively. 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.…”

Section: Discussionmentioning

confidence: 99%

“…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. 8 Though IE is associated with hypocomplementic glomerulonephritis, as was seen in this case, glomerulonephritis as a complication of B. henselae endocarditis is rare, with few reported cases.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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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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“…Thus, culture of B. quintana is not routinely implemented in numerous hospital settings. Furthermore, some of the more severe B. quintana manifestations, such as endocarditis, are typically culture‐negative . Although the use of blind subcultures in enriched media after long‐term blood culture incubation (~3 weeks) may increase B. quintana isolation , the long time from sampling to results limits clinical utility.…”

Section: The Presentmentioning

confidence: 99%

“…Furthermore, some of the more severe B. quintana manifestations, such as endocarditis, are typically culture‐negative . Although the use of blind subcultures in enriched media after long‐term blood culture incubation (~3 weeks) may increase B. quintana isolation , the long time from sampling to results limits clinical utility. Serological tools have provided optimal results, with the immunofluorescent assay (IFA) being the technique most commonly used .…”

Section: The Presentmentioning

confidence: 99%

Bartonella quintana, past, present, and future of the scourge of World War I

Ruiz¹

2018

APMIS

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During World War I, a mysterious new disease affected soldiers on both sides of battle field. The first reports described a relapsing fever of unknown origin with body lice being suggested as the vector. The outbreak affected >1 000 000 people, mostly soldiers fighting in front‐line trenches. Shortly afterward, the illness was known as Trench fever, of which the causal infectious agent is currently classified as Bartonella quintana.

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Interpretation and Relevance of Advanced Technique Results

Stratton¹,

Tang²

2018

Advanced Techniques in Diagnostic Microbiology

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Laboratory Approach to the Diagnosis of Culture-Negative Infective Endocarditis

Cited by 44 publications

References 64 publications

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

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

Bartonella quintana, past, present, and future of the scourge of World War I

Interpretation and Relevance of Advanced Technique Results

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