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, greater 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 . A significant proportion (range of 40 to 90 percent) have prior cardiac valvular disease [3,11,15]. As an example, 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) . The epidemiologic features of patients with documented Bartonella endocarditis are described above. (See 'Epidemiology' above.)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- CLINICAL MANIFESTATIONS
- Approach to diagnosis
- Diagnostic tests
- - Culture
- - Serology
- - Polymerase chain reaction
- - Histopathology
- Antimicrobial therapy
- - Preferred antimicrobial regimen
- Suspected Bartonella endocarditis
- Proven Bartonella endocarditis
- - Alternative agents
- - Rationale
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS