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]. A group of French investigators have generated the majority of reports on endocarditis caused by Bartonella, including several multicenter international studies that involved patients from France, England, and Canada [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]. More than 95 percent of the cases, however, 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 the 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, more than 70 percent of cases have involved men .
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 described Bartonella endocarditis 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) . (See "Clinical manifestations and evaluation of adults with suspected native valve endocarditis".)
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