New insight into the diagnosis of fastidious bacterial endocarditis

Abstract

Sterile blood cultures are noted in one third of patients with infectious endocarditis. Although in half of cases this is due to previous antibiotic therapy, in the other half, the aetiology of culture-negative endocarditis is intracellular bacteria such as Coxiella burnetii or fastidious growing bacteria. Although it was previously considered that the prevalence of such organisms was identical throughout the world, recent investigations on Bartonella endocarditis clearly showed that the aetiology of culture-negative endocarditis is likely to be strongly related to epidemiology of the agent in each country. During the past decade the use of molecular techniques such as PCR with subsequent sequencing to detect or to identify bacteria in valves from patients with infectious endocarditis have considerably improved the aetiological diagnosis. This is especially true in the case of culture-negative endocarditis following earlier antibiotic therapy. However, the fact that DNA remnants of past endocarditis can be detected some time after the acute episode, when the patient has been cured, suggests that the predictive value of these techniques along with the traditional histology and culture need to be evaluated closely.

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

“…arupensis (11), Bartonella koehlerae (12), Bartonella alsatica (13,14), and "Candidatus Bartonella mayotimonensis" (15), have occasionally been reported in the literature. Epidemiological data suggest a European-African gradient distribution in the prevalence of Bartonella endocarditis, the highest prevalence being reported in southern countries (7). In Europe, the prevalence of Bartonella endocarditis among those with infective endocarditis is 0% in Sweden, 1.1% in the United Kingdom, and 3% in France and Germany (7), and it reaches 15.6% and 9.8% in Algeria (16) and Tunisia (17), respectively.…”

“…Bartonella species were first recognized as endocarditis agents in 1993 when 3 such cases were reported (3)(4)(5). After the seminal work of Drancourt et al (6), 120 cases were reported in the literature until 2006 (7). Most reported cases were attributed to Bartonella quintana, the agent of trench fever that may also cause endocarditis, chronic bacteremia, and bacillary angiomatosis, and Bartonella henselae, which mainly causes cat scratch disease, endocarditis, bacillary angiomatosis, peliosis hepatis, and osteomyelitis (8).…”

“…Most reported cases were attributed to Bartonella quintana, the agent of trench fever that may also cause endocarditis, chronic bacteremia, and bacillary angiomatosis, and Bartonella henselae, which mainly causes cat scratch disease, endocarditis, bacillary angiomatosis, peliosis hepatis, and osteomyelitis (8). B. quintana primarily infects homeless people infested with body lice, whereas B. henselae is associated with patients with a previous valvulopathy and contact with cats (2,7,8). Single cases of endocarditis caused by other Bartonella species, including Bartonella elizabethae (4), Bartonella vinsonii subsp.…”

Contributions of ENDOBACT multicentric study to the infective endocarditis etiology in Romania

“…Blood culture negative endocarditis (BCNE) represents a well-known clinical problem occurring in large range of patients (2.5 -31%) among IE cases (7,8,16,17). Blood sampling after previous antibiotic treatment, and/or the presence of fastidious microorgan-isms (e.g.…”

“…Gram negative bacilli belonging to HACEK group, nutritionally deficient streptococci, intracellular bacteria) are listed among the causes of blood culture negative cases. An important amount of BCNE may be due to Q fever endocarditis, determined by a chronic infection with Coxiella burnetii (16).…”