Endocarditis caused by Bartonella
- David H Spach, MD
David H Spach, MD
- Professor of Medicine
- Division of Infectious Diseases
- University of Washington
Bartonella was first described as a cause of endocarditis in two separate reports in 1993 [1,2], and subsequently has become appreciated as a significant cause of "culture-negative" endocarditis [3-11]. Six Bartonella species have been reported to cause infective endocarditis in humans: B. quintana, B. henselae, B. elizabethae, B. vinsonii, B. koehlerae, and B. alsatica [3,12,13]. However, more than 95 percent of the cases have involved either B. quintana or B. henselae.
Bartonella endocarditis will be reviewed here. Other aspects of Bartonella infection are discussed separately. (See "Microbiology, epidemiology, clinical manifestations, and diagnosis of cat scratch disease" and "Epidemiology and clinical manifestations of Bartonella infections in HIV-infected patients" and "Clinical features, diagnosis, and treatment of Bartonella quintana infections" and "South American bartonellosis: Oroya fever and verruga peruana".)
The epidemiologic features of patients documented to have Bartonella endocarditis have varied considerably. Most reports have involved adult patients, although several cases have been described in children [10,14]. Overall, greater than 70 percent of cases have involved men . In the largest series, which included 22 patients, approximately 55 percent had evidence of pre-existing cardiac valvular disease .
Available data suggest that homelessness, alcoholism, and infestation with body lice are associated with B. quintana endocarditis, whereas contact with cats and previous valvular disease serve as the major risk factors for B. henselae endocarditis [3,4,11,15]. Case reports have also described Bartonella endocarditis in HIV-infected patients . (See "Epidemiology and clinical manifestations of Bartonella infections in HIV-infected patients".)
Patients with Bartonella endocarditis have clinical manifestations similar to other patients with subacute bacterial endocarditis as described by the Duke criteria (table 1 and table 2) . Affected patients typically present with subacute, nonspecific symptoms including fever, fatigue, weakness, and weight loss. In addition, most patients have evidence of a murmur on cardiac auscultation. (See "Clinical manifestations and evaluation of adults with suspected native valve endocarditis".)
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- Zeaiter Z, Fournier PE, Greub G, Raoult D. Diagnosis of Bartonella endocarditis by a real-time nested PCR assay using serum. J Clin Microbiol 2003; 41:919.
- Lepidi H, Fournier PE, Raoult D. Quantitative analysis of valvular lesions during Bartonella endocarditis. Am J Clin Pathol 2000; 114:880.
- Rolain JM, Brouqui P, Koehler JE, et al. Recommendations for treatment of human infections caused by Bartonella species. Antimicrob Agents Chemother 2004; 48:1921.
- Baddour LM, Wilson WR, Bayer AS, et al. Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. Circulation 2005; 111:e394.
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- CLINICAL MANIFESTATIONS
- Approach to diagnosis
- Diagnostic tests
- - Culture
- - Serology
- - Polymerase chain reaction
- - Histopathology
- Preferred antimicrobial regimen
- - Suspected Bartonella endocarditis
- - Proven Bartonella endocarditis
- Alternative agents
- SUMMARY AND RECOMMENDATIONS