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Kitamura M, Dasgupta A, Henricks J, Parikh SV, Nadasdy T, Clark E, Bazan JA, Satoskar AA. Clinicopathological differences between Bartonella and other bacterial endocarditis-related glomerulonephritis - our experience and a pooled analysis. FRONTIERS IN NEPHROLOGY 2024; 3:1322741. [PMID: 38288381 PMCID: PMC10823370 DOI: 10.3389/fneph.2023.1322741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/27/2023] [Indexed: 01/31/2024]
Abstract
Background Although Staphylococcus aureus is the leading cause of acute infective endocarditis (IE) in adults, Bartonella spp. has concomitantly emerged as the leading cause of "blood culture-negative IE" (BCNE). Pre-disposing factors, clinical presentation and kidney biopsy findings in Bartonella IE-associated glomerulonephritis (GN) show subtle differences and some unique features relative to other bacterial infection-related GNs. We highlight these features along with key diagnostic clues and management approach in Bartonella IE-associated GN. Methods We conducted a pooled analysis of 89 cases of Bartonella IE-associated GN (54 published case reports and case series; 18 published conference abstracts identified using an English literature search of several commonly used literature search modalities); and four unpublished cases from our institution. Results Bartonella henselae and Bartonella quintana are the most commonly implicated species causing IE in humans. Subacute presentation, affecting damaged native and/or prosthetic heart valves, high titer anti-neutrophil cytoplasmic antibodies (ANCA), mainly proteinase-3 (PR-3) specificity, fastidious nature and lack of positive blood cultures of these Gram-negative bacilli, a higher frequency of focal glomerular crescents compared to other bacterial infection-related GNs are some of the salient features of Bartonella IE-associated GN. C3-dominant, but frequent C1q and IgM immunofluorescence staining is seen on biopsy. A "full-house" immunofluorescence staining pattern is also described but can be seen in IE -associated GN due to other bacteria as well. Non-specific generalized symptoms, cytopenia, heart failure and other organ damage due to embolic phenomena are the highlights on clinical presentation needing a multi-disciplinary approach for management. Awareness of the updated modified Duke criteria for IE, a high index of suspicion for underlying infection despite negative microbiologic cultures, history of exposure to animals, particularly infected cats, and use of send-out serologic tests for Bartonella spp. early in the course of management can help in early diagnosis and initiation of appropriate treatment. Conclusion Diagnosis of IE-associated GN can be challenging particularly with BCNE. The number of Bartonella IE-associated GN cases in a single institution tends to be less than IE due to gram positive cocci, however Bartonella is currently the leading cause of BCNE. We provide a much-needed discussion on this topic.
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Affiliation(s)
- Mineaki Kitamura
- Department of Pathology, Division of Renal and Transplant Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Alana Dasgupta
- Department of Pathology, Division of Renal and Transplant Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Jonathan Henricks
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Samir V. Parikh
- Department of Internal Medicine, Division of Nephrology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Tibor Nadasdy
- Department of Pathology, Division of Renal and Transplant Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Edward Clark
- Department of Internal Medicine, St. Vincent Hospital, Erie, PA, United States
| | - Jose A. Bazan
- Department of Internal Medicine, Division of Infectious Disease, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Anjali A. Satoskar
- Department of Pathology, Division of Renal and Transplant Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
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Santhanam H, Nguyen MHN, Muthukumarasamy N, Mehta A, Francisco MT, Fountain RR, Helmstetter NJ. Bartonella endocarditis in patients with right ventricle-to-pulmonary artery conduit: 2 case reports and literature review. IDCases 2021; 26:e01306. [PMID: 34722156 PMCID: PMC8536538 DOI: 10.1016/j.idcr.2021.e01306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 10/06/2021] [Indexed: 12/01/2022] Open
Abstract
Bartonella species are Gram-negative bacilli and fastidious bacteria that can cause a number of clinical syndromes, including blood culture-negative infective endocarditis (IE). The two most commonly isolated species in humans are Bartonella quintana, the agent of trench fever, and Bartonella henselae, mostly known for causing cat scratch disease (Edouard et al., 2015 [1]; Edouard and Raoult, 2010 [2]). Both species also cause bacillary angiomatosis, primarily in immunocompromised patients (Edouard et al., 2015 [1]; Fournier et al., 2001 [3]). The risk of B. henselae IE is increased in patients with cardiac valvular disease and congenital heart disease (CHD) (Edouard and Raoult, 2010 [2]; Das et al., 2009 [4]; Abandeh et al., 2012 [5]; Ouellette et al., 2016 [6]; Hoffman et al., 2007 [7]; Georgievskaya et al., 2014 [8]). In this article, we detail two cases of Bartonella IE in patients with right ventricle-to-pulmonary artery (RV-PA) conduits who presented to our institution. We also perform a literature review on Bartonella IE in patients with a history of RV-PA conduit or pulmonary valve replacement.
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Affiliation(s)
- Haripriya Santhanam
- Department of Pediatrics and Adolescent Medicine, Western Michigan University Homer Stryker MD School of Medicine, 1000 Oakland Dr, Kalamazoo, MI 49008, USA
| | - Minh H N Nguyen
- Department of Pediatrics and Adolescent Medicine, Western Michigan University Homer Stryker MD School of Medicine, 1000 Oakland Dr, Kalamazoo, MI 49008, USA.,Department of Medicine, Western Michigan University Homer Stryker MD School of Medicine, 1000 Oakland Dr, Kalamazoo, MI 49008, USA
| | - Nirmal Muthukumarasamy
- Department of Medicine, Western Michigan University Homer Stryker MD School of Medicine, 1000 Oakland Dr, Kalamazoo, MI 49008, USA
| | - Aditya Mehta
- Department of Medicine, Western Michigan University Homer Stryker MD School of Medicine, 1000 Oakland Dr, Kalamazoo, MI 49008, USA
| | - Michael T Francisco
- Department of Hematology/Oncology, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA
| | - Robin R Fountain
- Bronson Methodist Hospital, Pediatric Cardiology, 601 John St, Kalamazoo, MI 49007, USA
| | - Nicholas J Helmstetter
- Department of Pediatrics and Adolescent Medicine, Western Michigan University Homer Stryker MD School of Medicine, 1000 Oakland Dr, Kalamazoo, MI 49008, USA.,Department of Medicine, Western Michigan University Homer Stryker MD School of Medicine, 1000 Oakland Dr, Kalamazoo, MI 49008, USA
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3
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Fenton H, McBurney S, Elsmo EJ, Cleveland CA, Yabsley MJ. Lesions associated with Bartonella taylorii-like bacterium infection in a free-ranging, young-of-the-year raccoon from Prince Edward Island, Canada. J Vet Diagn Invest 2021; 33:362-365. [PMID: 33463406 DOI: 10.1177/1040638720988515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A young-of-the year, female raccoon was presented with clinical signs of weakness and tremors. The raccoon was euthanized, and autopsy findings included poor body condition, diffuse lymphadenopathy, and pale, firm kidneys with petechial hemorrhages throughout the renal cortex. Histologic lesions included systemic fibrinoid vascular necrosis and severe renal lesions, including lymphoplasmacytic interstitial nephritis and fibrinosuppurative glomerulonephritis. Inflammatory vascular lesions were also present within the uvea, heart, lymph nodes, and the lamina propria of the gastric wall. Ancillary testing was negative for Borrelia burgdorferi, Leptospira sp., Aleutian disease virus, canine distemper virus, feline coronavirus, porcine circovirus 2, and rabies virus. Transmission electron microscopy revealed large numbers of ~1.3 × 0.35 µm bacterial rods surrounded by a trilaminar cell wall located within the glomeruli and associated with aggregates of fibrin and vascular damage. Analysis of partial citrate synthase gene and 16S-23S ribosomal RNA intergenic spacer region sequences from kidney tissue confirmed that the organism was a Bartonella spp. that was related to numerous Bartonella spp. from shrews in Europe. This group formed a sister clade to the genetically diverse Bartonella taylorii group that has been reported from a wide range of Eurasian rodent and flea species.
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Affiliation(s)
- Heather Fenton
- Southeastern Cooperative Wildlife Disease Study, The University of Georgia, Athens, GA.,Canadian Wildlife Health Cooperative, Atlantic Region, University of Prince Edward Island, Charlottetown, PEI, Canada
| | - Scott McBurney
- Canadian Wildlife Health Cooperative, Atlantic Region, University of Prince Edward Island, Charlottetown, PEI, Canada
| | - Elizabeth J Elsmo
- Southeastern Cooperative Wildlife Disease Study, The University of Georgia, Athens, GA.,Wisconsin Veterinary Diagnostic Laboratory, Madison, WI
| | - Christopher A Cleveland
- Southeastern Cooperative Wildlife Disease Study and Warnell School of Forestry and Natural Resources, The University of Georgia, Athens, GA
| | - Michael J Yabsley
- Southeastern Cooperative Wildlife Disease Study and Warnell School of Forestry and Natural Resources, The University of Georgia, Athens, GA
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4
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McElhinney DB. Prevention and management of endocarditis after transcatheter pulmonary valve replacement: current status and future prospects. Expert Rev Med Devices 2020; 18:23-30. [PMID: 33246368 DOI: 10.1080/17434440.2021.1857728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: Transcatheter pulmonary valve replacement (TPVR) has become an important tool in the management of congenital heart disease with abnormalities of the right ventricular outflow tract. Endocarditis is one of the most serious adverse long-term outcomes and among the leading causes of death in patients with congenital heart disease and after (TPVR).Areas covered: This review discusses the current state knowledge about the risk factors for and outcomes of endocarditis after transcatheter pulmonary valve replacement in patients with congenital and acquired heart disease. It also addresses practical measures for mitigating endocarditis risk, as well as diagnosing and managing endocarditis when it does occur.Expert opinion: With increasing understanding of the risk factors for and management and outcomes of endocarditis in patients who have undergone TPVR, we continue to learn how to utilize TPVR most effectively in this complex population of patients.
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Affiliation(s)
- Doff B McElhinney
- Departments of Cardiothoracic Surgery and Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, CA, USA
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5
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Abdelghani M, Nassif M, Blom NA, Van Mourik MS, Straver B, Koolbergen DR, Kluin J, Tijssen JG, Mulder BJM, Bouma BJ, de Winter RJ. Infective Endocarditis After Melody Valve Implantation in the Pulmonary Position: A Systematic Review. J Am Heart Assoc 2018; 7:JAHA.117.008163. [PMID: 29934419 PMCID: PMC6064882 DOI: 10.1161/jaha.117.008163] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Infective endocarditis (IE) after transcatheter pulmonary valve implantation (TPVI) in dysfunctioning right ventricular outflow tract conduits has evoked growing concerns. We aimed to investigate the incidence and the natural history of IE after TPVI with the Melody valve through a systematic review of published data. Methods and Results PubMed, EMBASE, and Web of Science databases were systematically searched for articles published until March 2017, reporting on IE after TPVI with the Melody valve. Nine studies (including 851 patients and 2060 patient‐years of follow‐up) were included in the analysis of the incidence of IE. The cumulative incidence of IE ranged from 3.2% to 25.0%, whereas the annualized incidence rate ranged from 1.3% to 9.1% per patient‐year. The median (interquartile range) time from TPVI to the onset of IE was 18.0 (9.0–30.4) months (range, 1.0–72.0 months). The most common findings were positive blood culture (93%), fever (89%), and new, significant, and/or progressive right ventricular outflow tract obstruction (79%); vegetations were detectable on echocardiography in only 34% of cases. Of 69 patients with IE after TPVI, 6 (8.7%) died and 35 (52%) underwent surgical and/or transcatheter reintervention. Death or reintervention was more common in patients with new/significant right ventricular outflow tract obstruction (69% versus 33%; P=0.042) and in patients with non‐streptococcal IE (73% versus 30%; P=0.001). Conclusions The incidence of IE after implantation of a Melody valve is significant, at least over the first 3 years after TPVI, and varies considerably between the studies. Although surgical/percutaneous reintervention is a common consequence, some patients can be managed medically, especially those with streptococcal infection and no right ventricular outflow tract obstruction.
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Affiliation(s)
- Mohammad Abdelghani
- Department of Cardiology, Academic Medical Center, University of Amsterdam, the Netherlands
| | - Martina Nassif
- Department of Cardiology, Academic Medical Center, University of Amsterdam, the Netherlands
| | - Nico A Blom
- Department of Cardiology, Academic Medical Center, University of Amsterdam, the Netherlands.,Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Martijn S Van Mourik
- Department of Cardiology, Academic Medical Center, University of Amsterdam, the Netherlands
| | - Bart Straver
- Department of Pediatric Cardiology, Academic Medical Center, University of Amsterdam, the Netherlands
| | - David R Koolbergen
- Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - Jolanda Kluin
- Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - Jan G Tijssen
- Department of Cardiology, Academic Medical Center, University of Amsterdam, the Netherlands
| | - Barbara J M Mulder
- Department of Cardiology, Academic Medical Center, University of Amsterdam, the Netherlands.,Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands
| | - Berto J Bouma
- Department of Cardiology, Academic Medical Center, University of Amsterdam, the Netherlands
| | - Robbert J de Winter
- Department of Cardiology, Academic Medical Center, University of Amsterdam, the Netherlands
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Hashemi H, Endicott-Yazdani TR, Oguayo C, Harmon DM, Tran T, Tsai-Nguyen G, Benavides R, Spak CW, Nguyen HL. Bartonella endocarditis with glomerulonephritis in a patient with complete transposition of the great arteries. Proc (Bayl Univ Med Cent) 2018; 31:102-104. [PMID: 29686571 DOI: 10.1080/08998280.2017.1400296] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
We describe a patient with history of dextro-transposition of the great vessels, ventricular septal defect, and pulmonary valve replacement who presented with fatigue, prolonged fever, and leg edema. He was found to have kidney injury, pancytopenia, and liver congestion. Echocardiogram revealed thickened leaflets with prolapsing vegetation on the pulmonary valve. Given the negative blood cultures, high Bartonella henselae immunogobulin G titer (≥1:1024) and positive immunoglobulin M titer (≥1:20), he was diagnosed with Bartonella endocarditis complicated with glomerulonephritis.
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Affiliation(s)
- Helen Hashemi
- Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
| | | | - Christopher Oguayo
- Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
| | | | - Tuan Tran
- Department of Pathology, Baylor University Medical Center, Dallas, Texas
| | - Ginger Tsai-Nguyen
- Department of Pulmonary and Critical Care, Baylor University Medical Center, Dallas, Texas
| | - Raul Benavides
- Department of Pathology, Baylor University Medical Center, Dallas, Texas
| | - Cedric W Spak
- Division of Infectious Diseases, Baylor Scott & White All Saints Medical Center, Fort Worth, Texas
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8
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Multiorgan Involvement Confounding the Diagnosis of Bartonella henselae Infective Endocarditis in Children With Congenital Heart Disease. Pediatr Infect Dis J 2017; 36:516-520. [PMID: 28403058 DOI: 10.1097/inf.0000000000001510] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Two children with congenital heart disease status post surgical correction presented with prolonged constitutional symptoms, hepatosplenomegaly and pancytopenia. Concern for malignancy prompted bone marrow biopsies that were without evidence thereof. In case 1, echocardiography identified a multilobulated vegetation on the conduit valve. In case 2, transthoracic, transesophageal and intracardiac echocardiography were performed and were without evidence of cardiac vegetations; however, pulmonic emboli raised concern for infective endocarditis. Both patients underwent surgical resection of the infected material and had histopathologic evidence of infective endocarditis. Further diagnostics identified elevated cytoplasmic antineutrophil cytoplasmic antibodies and antiproteinase 3 antibodies in addition to acute kidney injury with crescentic glomerulonephritis on renal biopsy. Serologic evidence of infection with Bartonella henselae was observed in both patients. These 2 cases highlight the potential multiorgan involvement that may confound the diagnosis of culture-negative infective endocarditis caused by B. henselae.
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9
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Affiliation(s)
- Doff B. McElhinney
- From the Lucille Packard Children’s Hospital, Stanford University School of Medicine, Palo Alto, CA
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10
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Sosa T, Goldstein B, Cnota J, Bryant R, Frenck R, Washam M, Madsen N. Melody Valve Bartonella henselae Endocarditis in an Afebrile Teen: A Case Report. Pediatrics 2016; 137:peds.2015-1548. [PMID: 26659816 DOI: 10.1542/peds.2015-1548] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2015] [Indexed: 11/24/2022] Open
Abstract
Significant advancements in the care of children with cardiac valve disease over the past 15 years have led to the increasingly common use of percutaneous transcatheter valve implantation as an alternative to surgical replacement in selected patient populations. Although the transcatheter approach has several advantages, this approach and the valves used are not without complications. Bacterial endocarditis is a known and concerning complication after transcatheter pulmonary valve replacement (TPVR). Most reported cases have involved organisms that are common etiologic agents of bacterial endocarditis and are readily identified via blood culture. However, culture-negative endocarditis in the setting of TPVR has not been well described. We present our experience with one afebrile teenager with culture-negative, serology-positive Bartonella henselae endocarditis of a Melody valve 18 months after TPVR for management of tetralogy of Fallot. The teen was successfully managed with long-term antibiotic therapy followed by surgical replacement of the valve. To our knowledge, this is the first reported case of culture-negative endocarditis of a Melody TPVR in the absence of fever. This report discusses the importance of considering culture-negative endocarditis in the differential diagnosis of an afebrile patient with TPVR presenting with constitutional symptoms and valve dysfunction, particularly in the primary care setting. It is anticipated that with an increase in the successfully aging population of children who have undergone cardiac repair, the evaluation of these patients will become an increasingly important and common task for the community pediatrician.
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Affiliation(s)
- Tina Sosa
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Bryan Goldstein
- Department of Pediatric Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - James Cnota
- Department of Pediatric Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Roosevelt Bryant
- Department of Pediatric Cardiac Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Robert Frenck
- Department of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Matthew Washam
- Department of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Nicolas Madsen
- Department of Pediatric Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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