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Aranda-Domene R, Sandoval E, Cuervo G, Fernández-Pittol M, de la María CG, Quintana E. Bartonella quintana pulmonary native valve endocarditis. Indian J Thorac Cardiovasc Surg 2024; 40:150-154. [PMID: 38827541 PMCID: PMC11139838 DOI: 10.1007/s12055-024-01727-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 06/04/2024] Open
Abstract
Bartonella quintana is a well-known cause of blood culture-negative endocarditis; however, pulmonary valve involvement is rare. The case of a 40-year-old African male who presented to the Emergency Department with chest pain, cardiac failure, and a 2-week history of fever is presented. Transoesophageal echocardiography confirmed an atrial septal defect, severe pulmonary insufficiency with large vegetations, severe mitral regurgitation due to anterior leaflet prolapse, and right ventricular dysfunction. Empirical antibiotic therapy was started, and urgent surgical intervention was decided. There were vegetations on the three pulmonary valve leaflets and the mitral valve. Closure of the atrial septal defect, mitral and tricuspid valve repair, pulmonary valve replacement with a biological prosthesis, and infundibuloplasty of the right ventricle were performed. The postoperative course was uneventful. Preoperative blood cultures were negative, and B. quintana was detected through 16S rRNA gene amplification and sequencing in mitral and pulmonary implants. Serology showed positive titers of 1/1260 for both B. quintana and B. henselae. Ceftriaxone and gentamicin were administered for 10 days, followed by oral doxycycline for 12 weeks. A one-year echocardiogram showed normal functioning of the pulmonary prosthesis and the mitral and tricuspid repair. Infection caused by B. quintana is a rare cause of endocarditis with negative blood cultures, and multivalvular and pulmonary valve involvement is exceptional. Supplementary Information The online version contains supplementary material available at 10.1007/s12055-024-01727-4.
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Affiliation(s)
- Ramón Aranda-Domene
- Cardiovascular Surgery Department, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Spain
| | - Elena Sandoval
- Cardiovascular Surgery Department, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Spain
| | - Guillermo Cuervo
- Department of Infectious Diseases, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Mariana Fernández-Pittol
- Department of Microbiology, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Spain
| | | | - Eduard Quintana
- Cardiovascular Surgery Department, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Spain
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Boodman C, Gupta N, Nelson CA, van Griensven J. Bartonella quintana Endocarditis: A Systematic Review of Individual Cases. Clin Infect Dis 2024; 78:554-561. [PMID: 37976173 DOI: 10.1093/cid/ciad706] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/30/2023] [Accepted: 11/15/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Bartonella quintana is a louse-borne bacterium that remains a neglected cause of endocarditis in low-resource settings. Our understanding of risk factors, clinical manifestations, and treatment of B. quintana endocarditis are biased by older studies from high-income countries. METHODS We searched Pubmed Central, Medline, Scopus, Embase, EBSCO (CABI) Global Health, Web of Science and international trial registers for articles published before March 2023 with terms related to Bartonella quintana endocarditis. We included articles containing case-level information on B. quintana endocarditis and extracted data related to patient demographics, clinical features, diagnostic testing, treatment, and outcome. RESULTS A total of 975 records were identified, of which 569 duplicates were removed prior to screening. In total, 84 articles were eligible for inclusion, describing a total of 167 cases. Infections were acquired in 40 different countries; 62 cases (37.1%) were acquired in low- and middle-income countries (LMICs). Disproportionately more female and pediatric patients were from LMICs. More patients presented with heart failure (n = 70/167 [41.9%]) than fever (n = 65/167 [38.9%]). Mean time from symptom onset to presentation was 5.1 months. Also, 25.7% of cases (n = 43/167) were associated with embolization, most commonly to the spleen and brain; 65.5% of antimicrobial regimens included doxycycline. The vast majority of cases underwent valve replacement surgery (n = 154/167, [98.0%]). Overall case fatality rate was 9.6% (n = 16/167). CONCLUSIONS B. quintana endocarditis has a global distribution, and long delays between symptom onset and presentation frequently occur. Improved clinician education and diagnostic capacity are needed to screen at-risk populations and identify infection before endocarditis develops.
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Affiliation(s)
- Carl Boodman
- Division of Infectious Diseases, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Unit of HIV and Neglected Tropical Diseases, Institute of Tropical Medicine, Antwerp, Belgium
| | - Nitin Gupta
- Department of Infectious Disease, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Christina A Nelson
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
| | - Johan van Griensven
- Unit of HIV and Neglected Tropical Diseases, Institute of Tropical Medicine, Antwerp, Belgium
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Meidrops K, Groma V, Goldins NR, Apine L, Skuja S, Svirskis S, Gudra D, Fridmanis D, Stradins P. Understanding Bartonella-Associated Infective Endocarditis: Examining Heart Valve and Vegetation Appearance and the Role of Neutrophilic Leukocytes. Cells 2023; 13:43. [PMID: 38201247 PMCID: PMC10778237 DOI: 10.3390/cells13010043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND The endocardium and cardiac valves undergo severe impact during infective endocarditis (IE), and the formation of vegetation places IE patients at a heightened risk of embolic complications and mortality. The relevant literature indicates that 50% of IE cases exhibit structurally normal cardiac valves, with no preceding history of heart valve disease. Gram-positive cocci emerge as the predominant causative microorganisms in IE, while Gram-negative Bartonella spp., persisting in the endothelium, follow pathogenic pathways distinct from those of typical IE-causing agents. Employing clinical as well as advanced microbiological and molecular assays facilitated the identification of causative pathogens, and various morphological methods were applied to evaluate heart valve damage, shedding light on the role of neutrophilic leukocytes in host defense. In this research, the immunohistochemical analysis of neutrophilic leukocyte activation markers such as myeloperoxidase, neutrophil elastase, calprotectin, and histone H3, was performed. A distinct difference in the expression patterns of these markers was observed when comparing Bartonella spp.-caused and non-Bartonella spp.-caused IE. The markers exhibited significantly higher expression in non-Bartonella spp.-caused IE compared to Bartonella spp.-caused IE, and they were more prevalent in vegetation than in the valvular leaflets. Notably, the expression of these markers in all IE cases significantly differed from that in control samples. Furthermore, we advocated the use of 16S rRNA Next-Generation Sequencing on excised heart valves as an effective diagnostic tool for IE, particularly in cases where blood cultures yielded negative results. The compelling results achieved in this study regarding the enigmatic nature of Bartonella spp. IE's pathophysiology contribute significantly to our understanding of the peculiarities of inflammation and immune responses.
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Affiliation(s)
- Kristians Meidrops
- Riga Stradins University, 16 Dzirciema Street, LV-1007 Riga, Latvia (L.A.); (P.S.)
- Centre of Cardiac Surgery, Pauls Stradins Clinical University Hospital, 13 Pilsonu Street, LV-1002 Riga, Latvia
| | - Valerija Groma
- Riga Stradins University, 16 Dzirciema Street, LV-1007 Riga, Latvia (L.A.); (P.S.)
- Joint Laboratory of Electron Microscopy, Riga Stradins University, 9 Kronvalda Boulevard, LV-1010 Riga, Latvia
| | - Niks Ricards Goldins
- Riga Stradins University, 16 Dzirciema Street, LV-1007 Riga, Latvia (L.A.); (P.S.)
| | - Lauma Apine
- Riga Stradins University, 16 Dzirciema Street, LV-1007 Riga, Latvia (L.A.); (P.S.)
| | - Sandra Skuja
- Riga Stradins University, 16 Dzirciema Street, LV-1007 Riga, Latvia (L.A.); (P.S.)
- Joint Laboratory of Electron Microscopy, Riga Stradins University, 9 Kronvalda Boulevard, LV-1010 Riga, Latvia
| | - Simons Svirskis
- Institute of Microbiology and Virology, Riga Stradins University, Ratsupites Str. 5, LV-1067 Riga, Latvia;
| | - Dita Gudra
- Latvian Biomedical Research and Study Centre, LV-1067 Riga, Latvia; (D.G.); (D.F.)
| | - Davids Fridmanis
- Latvian Biomedical Research and Study Centre, LV-1067 Riga, Latvia; (D.G.); (D.F.)
| | - Peteris Stradins
- Riga Stradins University, 16 Dzirciema Street, LV-1007 Riga, Latvia (L.A.); (P.S.)
- Centre of Cardiac Surgery, Pauls Stradins Clinical University Hospital, 13 Pilsonu Street, LV-1002 Riga, Latvia
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Sarsiat L, Garrigos T, Houhamdi L, Dauwalder O, Kuli B, Braunberger E, Belmonte O, Fournier PE, Miltgen G. Case series of 12 Bartonella quintana endocarditis from the Southwest Indian Ocean. PLoS Negl Trop Dis 2023; 17:e0011606. [PMID: 37676863 PMCID: PMC10508605 DOI: 10.1371/journal.pntd.0011606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 09/19/2023] [Accepted: 08/20/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Bartonella spp. are fastidious bacteria frequently identified as the cause of blood culture-negative (BCN) endocarditis. However, Bartonella infections are difficult to diagnose in routine laboratory testing and their incidence is probably underestimated. We investigated the epidemiological and clinical features of Bartonella endocarditis cases diagnosed between 2009 and 2021 on Reunion Island (Southwest Indian Ocean). METHOD We retrospectively included all patients diagnosed with Bartonella endocarditis at Reunion Island University Hospital during this period. Endocarditis was diagnosed on the basis of microbiological findings, including serological tests (IFA) and PCR on cardiac valves, and the modified Duke criteria. We used then the multispacer typing (MST) method to genotype the available Bartonella strains. FINDINGS We report 12 cases of B. quintana endocarditis on Reunion Island (83.3% in men, median patient age: 32 years). All the patients originated from the Comoros archipelago. The traditional risk factors for B. quintana infection (homelessness, alcoholism, exposure to body lice) were absent in all but two of the patients, who reported head louse infestations in childhood. Previous heart disease leading to valve dysfunction was recorded in 50% of patients. All patients underwent cardiac valve surgery and antimicrobial therapy with a regimen including doxycycline. All patients presented high C-reactive protein concentrations, anemia and negative blood cultures. The titer of IgG antibodies against Bartonella sp. exceeded 1:800 in 42% of patients. Specific PCR on cardiac valves confirmed the diagnosis of B. quintana endocarditis in all patients. Genotyping by the MST method was performed on four strains detected in preserved excised valves and was contributive for three, which displayed the MST6 genotype. CONCLUSIONS Bartonella quintana is an important cause of infective endocarditis in the Comoros archipelago and should be suspected in patients with mitral valve dysfunction and BCN from this area.
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Affiliation(s)
- Ludivine Sarsiat
- Laboratoire de Bactériologie, CHU Félix Guyon, Saint-Denis, La Réunion, France
| | - Thomas Garrigos
- Laboratoire de Bactériologie, CHU Félix Guyon, Saint-Denis, La Réunion, France
- UMR Processus Infectieux en Milieu Insulaire Tropical (PIMIT), CNRS 9192, INSERM U1187, IRD 249, Université de La Réunion, Saint-Denis, La Réunion, France
| | - Linda Houhamdi
- CNR des Rickettsies, Coxiella et Bartonella, IHU-Méditerranée Infection, Marseille, France
| | - Olivier Dauwalder
- Plateau de Microbiologie Moléculaire Spécialisé et de Séquençage, Institut des Agents Infectieux, Centre de Biologie et Pathologie Nord, Hospices Civils de Lyon, Lyon, France
| | - Barbara Kuli
- Service de Maladies Infectieuses, CHU Félix Guyon, Saint-Denis, La Réunion, France
| | - Eric Braunberger
- Service de Chirurgie Cardio-thoracique, CHU Félix Guyon, Saint-Denis, La Réunion, France
| | - Olivier Belmonte
- Laboratoire de Bactériologie, CHU Félix Guyon, Saint-Denis, La Réunion, France
| | - Pierre-Edouard Fournier
- CNR des Rickettsies, Coxiella et Bartonella, IHU-Méditerranée Infection, Marseille, France
- UMR Vecteurs—Infections Tropicales et Méditerranéennes (VITROME), Université d’Aix-Marseille, IRD, AP-HM, SSA, IHU-Méditerranée Infection, Marseille, France
| | - Guillaume Miltgen
- Laboratoire de Bactériologie, CHU Félix Guyon, Saint-Denis, La Réunion, France
- UMR Processus Infectieux en Milieu Insulaire Tropical (PIMIT), CNRS 9192, INSERM U1187, IRD 249, Université de La Réunion, Saint-Denis, La Réunion, France
- Centre Régional en Antibiothérapie (CRAtb) de La Réunion, France
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Seroprevalence of Bartonella henselae and Bartonella quintana Infection and Impact of Related Risk Factors in People from Eastern Slovakia. Pathogens 2021; 10:pathogens10101261. [PMID: 34684210 PMCID: PMC8539311 DOI: 10.3390/pathogens10101261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 12/28/2022] Open
Abstract
The genus Bartonella is a rapidly expanding group of ubiquitous bacteria that occur mainly in different animal species, but some can also be transmitted to humans. Three species, B. henselae, B. bacilliformis, and B. quintana, are responsible for the majority of human cases. The severity of the clinical symptoms often depends on the immune status of the patient, but others factors such as the species of the pathogen, virulence factors, and bacterial load also can play an important role. As the information on the occurrence of bartonellosis in the human population in Slovakia is absent, the aim of our pilot study was to determine the seroprevalence against B. henselae and B. quintana in the population of people living in Eastern Slovakia, and to identify the impact of related risk factors. Of 536 people included in the study, 126 (23.5%) showed positivity for anti-B. henselae antibodies and 133 (24.8%) against B. quintana. A statistically higher prevalence was confirmed only in the case of B. quintana in women regardless of the risk group. In analyzing the risk factors, we found significant differences between B. henselae seropositive and seronegative groups only in uric acid levels and serum creatinine, both, however, clinically irrelevant. Significant, but clinically irrelevant differences were observed also in alanine aminotransferase (ALT) levels and creatinine in people seropositive to B. quintana.
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Kleinman DR, Lam JC, Bacani J, Tyrrell G, Turvey SL. Bartonella quintana infective endocarditis in northern Alberta: A case report. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2020; 5:256-260. [PMID: 36340060 PMCID: PMC9602878 DOI: 10.3138/jammi-2020-0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/26/2020] [Indexed: 06/16/2023]
Abstract
We present a case of Bartonella quintana infective endocarditis requiring valvular surgery in an Indigenous patient from northern Alberta that was identified months after initial presentation to hospital with undifferentiated laboratory abnormalities. Syndromes caused by B. quintana are often challenging to diagnose due to their non-specific presentation and the difficulty in detecting this organism using traditional culture methods. Additionally, risk factors for B. quintana include marginal housing and alcohol use disorder, which often impede access to health care. Indigenous patients in northern Canada often face worse health outcomes compared with other regions owing to poor economic conditions, substandard housing, and limited access to health care resources. Given that risk factors for B. quintana are prevalent throughout northern Canada and that this infection is difficult to diagnose, we surmise that the prevalence of B. quintana infection is underestimated in northern Canada.
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Affiliation(s)
- David Ryan Kleinman
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - John C Lam
- Division of Infectious Diseases, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Julinor Bacani
- Division of Anatomical Pathology, Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Gregory Tyrrell
- Division of Diagnostic and Applied Microbiology, Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Shannon Lee Turvey
- Division of Infectious Diseases, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
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