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Endocarditis caused by Bartonella

David H Spach, MD
Section Editor
Stephen B Calderwood, MD
Deputy Editor
Jennifer Mitty, MD, MPH


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 [11]. 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 [3].

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 [1]. (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) [16]. The epidemiologic features of patients with documented Bartonella endocarditis are described above. (See 'Epidemiology' above.)

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Literature review current through: Nov 2017. | This topic last updated: Feb 27, 2017.
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  1. Spach DH, Callis KP, Paauw DS, et al. Endocarditis caused by Rochalimaea quintana in a patient infected with human immunodeficiency virus. J Clin Microbiol 1993; 31:692.
  2. Daly JS, Worthington MG, Brenner DJ, et al. Rochalimaea elizabethae sp. nov. isolated from a patient with endocarditis. J Clin Microbiol 1993; 31:872.
  3. Raoult D, Fournier PE, Drancourt M, et al. Diagnosis of 22 new cases of Bartonella endocarditis. Ann Intern Med 1996; 125:646.
  4. Spach DH, Kanter AS, Daniels NA, et al. Bartonella (Rochalimaea) species as a cause of apparent "culture-negative" endocarditis. Clin Infect Dis 1995; 20:1044.
  5. Holmes AH, Greenough TC, Balady GJ, et al. Bartonella henselae endocarditis in an immunocompetent adult. Clin Infect Dis 1995; 21:1004.
  6. Drancourt M, Birtles R, Chaumentin G, et al. New serotype of Bartonella henselae in endocarditis and cat-scratch disease. Lancet 1996; 347:441.
  7. Hadfield TL, Warren R, Kass M, et al. Endocarditis caused by Rochalimaea henselae. Hum Pathol 1993; 24:1140.
  8. Jalava J, Kotilainen P, Nikkari S, et al. Use of the polymerase chain reaction and DNA sequencing for detection of Bartonella quintana in the aortic valve of a patient with culture-negative infective endocarditis. Clin Infect Dis 1995; 21:891.
  9. Breathnach AS, Hoare JM, Eykyn SJ. Culture-negative endocarditis: contribution of bartonella infections. Heart 1997; 77:474.
  10. Baorto E, Payne RM, Slater LN, et al. Culture-negative endocarditis caused by Bartonella henselae. J Pediatr 1998; 132:1051.
  11. Raoult D, Fournier PE, Vandenesch F, et al. Outcome and treatment of Bartonella endocarditis. Arch Intern Med 2003; 163:226.
  12. Avidor B, Graidy M, Efrat G, et al. Bartonella koehlerae, a new cat-associated agent of culture-negative human endocarditis. J Clin Microbiol 2004; 42:3462.
  13. Raoult D, Roblot F, Rolain JM, et al. First isolation of Bartonella alsatica from a valve of a patient with endocarditis. J Clin Microbiol 2006; 44:278.
  14. Posfay Barbe K, Jaeggi E, Ninet B, et al. Bartonella quintana endocarditis in a child. N Engl J Med 2000; 342:1841.
  15. Fournier PE, Lelievre H, Eykyn SJ, et al. Epidemiologic and clinical characteristics of Bartonella quintana and Bartonella henselae endocarditis: a study of 48 patients. Medicine (Baltimore) 2001; 80:245.
  16. Durack DT, Lukes AS, Bright DK. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. Am J Med 1994; 96:200.
  17. Edouard S, Nabet C, Lepidi H, et al. Bartonella, a common cause of endocarditis: a report on 106 cases and review. J Clin Microbiol 2015; 53:824.
  18. Klein JL, Nair SK, Harrison TG, et al. Prosthetic valve endocarditis caused by Bartonella quintana. Emerg Infect Dis 2002; 8:202.
  19. Kreisel D, Pasque MK, Damiano RJ Jr, et al. Bartonella species-induced prosthetic valve endocarditis associated with rapid progression of valvular stenosis. J Thorac Cardiovasc Surg 2005; 130:567.
  20. Khalighi MA, Nguyen S, Wiedeman JA, Palma Diaz MF. Bartonella endocarditis-associated glomerulonephritis: a case report and review of the literature. Am J Kidney Dis 2014; 63:1060.
  21. Van Haare Heijmeijer S, Wilmes D, Aydin S, et al. Necrotizing ANCA-Positive Glomerulonephritis Secondary to Culture-Negative Endocarditis. Case Rep Nephrol 2015; 2015:649763.
  22. Bruneel F, D'estanque J, Fournier PE, et al. Isolated right-sided Bartonella quintana endocarditis in an immunocompetent adult. Scand J Infect Dis 1998; 30:424.
  23. Fournier PE, Mainardi JL, Raoult D. Value of microimmunofluorescence for diagnosis and follow-up of Bartonella endocarditis. Clin Diagn Lab Immunol 2002; 9:795.
  24. Houpikian P, Raoult D. Blood culture-negative endocarditis in a reference center: etiologic diagnosis of 348 cases. Medicine (Baltimore) 2005; 84:162.
  25. Fournier PE, Thuny F, Richet H, et al. Comprehensive diagnostic strategy for blood culture-negative endocarditis: a prospective study of 819 new cases. Clin Infect Dis 2010; 51:131.
  26. Koehler JE, Quinn FD, Berger TG, et al. Isolation of Rochalimaea species from cutaneous and osseous lesions of bacillary angiomatosis. N Engl J Med 1992; 327:1625.
  27. Houpikian P, Raoult D. Western immunoblotting for Bartonella endocarditis. Clin Diagn Lab Immunol 2003; 10:95.
  28. Harris KA, Yam T, Jalili S, et al. Service evaluation to establish the sensitivity, specificity and additional value of broad-range 16S rDNA PCR for the diagnosis of infective endocarditis from resected endocardial material in patients from eight UK and Ireland hospitals. Eur J Clin Microbiol Infect Dis 2014; 33:2061.
  29. 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.
  30. Lepidi H, Fournier PE, Raoult D. Quantitative analysis of valvular lesions during Bartonella endocarditis. Am J Clin Pathol 2000; 114:880.
  31. Rolain JM, Brouqui P, Koehler JE, et al. Recommendations for treatment of human infections caused by Bartonella species. Antimicrob Agents Chemother 2004; 48:1921.
  32. 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.
  33. Baddour LM, Wilson WR, Bayer AS, et al. Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association. Circulation 2015; 132:1435.
  34. Wilson WR, Karchmer AW, Dajani AS, et al. Antibiotic treatment of adults with infective endocarditis due to streptococci, enterococci, staphylococci, and HACEK microorganisms. American Heart Association. JAMA 1995; 274:1706.
  35. Foucault C, Raoult D, Brouqui P. Randomized open trial of gentamicin and doxycycline for eradication of Bartonella quintana from blood in patients with chronic bacteremia. Antimicrob Agents Chemother 2003; 47:2204.
  36. Foucault C, Brouqui P, Raoult D. Bartonella quintana characteristics and clinical management. Emerg Infect Dis 2006; 12:217.
  37. Angelakis E, Raoult D. Pathogenicity and treatment of Bartonella infections. Int J Antimicrob Agents 2014; 44:16.