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Diagnosis of 22 New Cases of Bartonella Endocarditis

Didier Raoult, MD, PhD; Pierre E. Fournier, MD; Michel Drancourt, MD, PhD; Thomas J. Marrie, MD; Jerome Etienne, MD; Julie Cosserat, MD; Patrice Cacoub, MD; Yves Poinsignon, MD; Pascale Leclercq, MD; and Armine M. Sefton, MD
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From the Faculte de Medecine, Marseille, France; Victoria General Hospital, Halifax, Nova Scotia, Canada; Hopital Louis Pradel, Lyon, France; Centre Medical-Chirurgical Foch, Suresnes, France; Groupe Hospitalier Pitie-Salpetriere and Hopital Saint-Louis, Paris, France; Centre Hospitalier Universitaire Grenoble, Grenoble, France; and London Hospital Medical College, London, United Kingdom. Acknowledgments: The authors thank Dr. P. Brouqui, Marseille, France; Dr. J. Beaune, Lyon, France; and Dr. R. Leigh, Cape Town, South Africa, who took care of two patients. They also thank Dr. R. Birtles for reviewing the manuscript and Dr. H. Tissot Dupont for statistical analysis. Grant Support: In part by Programme Hospitalier de Recherche Clinique 1993, Assistance Publique a Marseille. Requests for Reprints: Didier Raoult, MD, PhD, Unite des Rickettsies, CNRS EPJ0054, Faculte de Medecine, 27 Boulevard Jean Moulin, 13385 Marseille, Cedex 05, France. Current Author Addresses: Drs. Raoult, Fournier, and Drancourt: Unite des Rickettsies, Faculte de Medecine, CNRS EPJ0054, 27, Boulevard Jean Moulin, 13385 Marseille Cedex 05, France.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1996;125(8):646-652. doi:10.7326/0003-4819-125-8-199610150-00004
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Background: Bartonella species are emerging pathogens that are seldom reported as a cause of blood culture-negative endocarditis.

Objective: To report the occurrence of, risk factors for, and clinical features of Bartonella endocarditis and to evaluate the diagnostic tools available for this condition.

Design: Case series and comparison with past series.

Setting: Multicenter international study in Halifax, Nova Scotia, Canada; Lyon, France; and Marseille, France.

Patients: 22 patients from France, England, Canada, and South Africa were investigated for blood culture-negative endocarditis.

Measurements: Titer of antibodies to Bartonella species by microimmunofluorescence assay, blood or vegetation culture, and amplification of Bartonella DNA from valvular tissue by polymerase chain reaction. Cross-adsorption was done for patients with antibodies to Chlamydia species.

Results: 22 patients had definite endocarditis. Five were infected with B. quintana, 4 with B. henselae, and 13 with an undetermined Bartonella species. These cases were compared with the 11 previously reported cases. Of the patients with the newly reported cases, 19 had valvular surgery and 6 died. Nine were homeless, 11 were alcoholic, 4 owned cats, and 13 had preexisting valvular heart disease. Bartonella species caused 3% of the cases of endocarditis seen in the three study centers. The patients with these cases could have previously received a diagnosis of chlamydial endocarditis because of apparently high levels of cross-reacting antibodies to Chlamydia species.

Conclusions: Bartonella species are an important cause of blood culture-negative endocarditis and can be identified by culture, serologic studies, or molecular biology techniques. Alcoholism and homelessness without previous valvular heart disease are risk factors for B. quintana infection but not for infection with other Bartonella species.

Figures

Grahic Jump Location
Figure 1. Transmission electron microscopy. Note the intracellular location of the organisms. Bacteria appear as dark dots ( ) because of a packed DNA (methanol-uranyl acetate and lead citrate; original magnification, × 5000). Higher magnification shows the trilamellar membrane (single arrow) and some dividing organisms (double arrows) (methanol-uranyl acetate and lead citrate; original magnification, × 15 000). M = mitochondria. Bar = 1 µm.
Human valve infected with Bartonella quintana. Top.arrowBottom.
Grahic Jump Location

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