1887

Abstract

Introduction:

Prior studies (predominantly from Europe) have demonstrated blood culture-negative endocarditis due to . Our objective was to describe three cases of endocarditis identified within one year at a large hospital in Washington, DC, USA.

Case presentation:

We constructed a descriptive case series from a retrospective review of medical records from April to December 2013 at an 800-bed urban hospital. All three patients (ages: 52, 55 and 57 years) were undomiciled/homeless men with a history of alcoholism. Although they had negative blood cultures, echocardiography demonstrated aortic/mitral valve perforation and regurgitation in one patient, aortic/mitral valve vegetation with mitral regurgitation in the second patient, and aortic valve vegetation with regurgitation in the third patient. The patients had positive serum immunoglobulin G (IgG) with negative immunoglobulin M (IgM). PCR on DNA extracted from cardiac valves was positive for , and DNA sequencing of PCR amplicons identified . Patients received treatment with doxycycline/rifampin or doxycycline/gentamicin.

Conclusion:

Clinicians should consider endocarditis as a differential diagnosis in patients who fit elements of the Duke Criteria, as well as having a history of homelessness and alcoholism.

Loading

Article metrics loading...

/content/journal/jmmcr/10.1099/jmmcr.0.005049
2016-07-11
2024-03-29
Loading full text...

Full text loading...

/deliver/fulltext/jmmcr/3/4/jmmcr005049.html?itemId=/content/journal/jmmcr/10.1099/jmmcr.0.005049&mimeType=html&fmt=ahah

References

  1. Avidor B., Graidy M., Efrat G., Leibowitz C., Shapira G., Schattner A., Zimhony O., Giladi M. 2004; Bartonella koehlerae, a new cat-associated agent of culture-negative human endocarditis. J Clin Microbiol 42:3462–3468 [View Article][PubMed]
    [Google Scholar]
  2. Birtles R. J. 1995; Differentiation of Bartonella species using restriction endonuclease analysis of PCR-amplified 16S rRNA genes. FEMS Microbiol Lett 129:[PubMed]
    [Google Scholar]
  3. Breitkopf C., Hammel D., Scheld H. H., Peters G., Becker K. 2005; Impact of a molecular approach to improve the microbiological diagnosis of infective heart valve endocarditis. Circulation 111:1415–1421 [View Article][PubMed]
    [Google Scholar]
  4. Cockerill F. R., Uhl J. R. 2002; Applications and challenges of real-time PCR for the clinical microbiology laboratory. In Rapid Cycle Real-Time PCR Methods and Applications pp 3–27 Edited by Reischl U., Wittwer C., Cockerill F. Berlin, Germany: Springer-Verlag; [CrossRef]
    [Google Scholar]
  5. Daly J. S., Worthington M. G., Brenner D. J., Moss C. W., Hollis D. G., Weyant R. S., Steigerwalt A. G., Weaver R. E., Daneshvar M. I. et al. 1993; Rochalimaea elizabethae sp. nov. isolated from a patient with endocarditis. J Clin Microbiol 31:872[PubMed]
    [Google Scholar]
  6. Foucalt C., Barrau K., Brouqui P., Raoult D. 2002; Bartonellaquintana bacteremia among homeless people. Clin Infect Dis 36:684–689 [CrossRef]
    [Google Scholar]
  7. Fournier P. E., Lelievre H., Eykyn S. J., Mainardi J. L., Marrie T. J., Bruneel F., Roure C., Nash J., Clave D. et al. 2001; Epidemiologic and clinical characteristics of Bartonella quintana and Bartonella henselae endocarditis: a study of 48 patients. Medicine 80:245–251 [View Article][PubMed]
    [Google Scholar]
  8. Fournier P. E., Thuny F., Richet H., Lepidi H., Casalta J. P., Arzouni J. P., Maurin M., Célard M., Mainardi J. L. et al. 2010; Comprehensive diagnostic strategy for blood culture-negative endocarditis: a prospective study of 819 new cases. Clin Infect Dis 51:131–140 [View Article][PubMed]
    [Google Scholar]
  9. Lamas C. C., Eykyn S. J. 2003; Blood culture negative endocarditis: analysis of 63 cases presenting over 25 years. Heart 89:258–262[PubMed] [CrossRef]
    [Google Scholar]
  10. Li J. S., Sexton D. J., Mick N., Nettles R., Fowler V. G., Ryan T., Bashore T., Corey G. R. 2000; Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis 30:633–638 [View Article][PubMed]
    [Google Scholar]
  11. Maggi R. G., Breitschwerdt E. B. 2005; Potential limitations of the 16S-23S rRNA intergenic region for molecular detection of Bartonella species. J Clin Microbiol 43:1171–1176 [View Article][PubMed]
    [Google Scholar]
  12. Maurin M., Raoult D. 1996; Bartonella (Rochalimaea) quintana infections. Clin Microbiol Rev 9:273–292[PubMed]
    [Google Scholar]
  13. Maurin M., Eb F., Etienne J., Raoult D. 1997; Serological cross-reactions between Bartonella and Chlamydia species: implications for diagnosis. J Clin Microbiol 35:2283–2287[PubMed]
    [Google Scholar]
  14. Ohl M. E., Spach D. H. 2000; Bartonella quintana and urban trench fever. Clin Infect Dis 31:131–135 [View Article][PubMed]
    [Google Scholar]
  15. Raoult D., Fournier P. E., Drancourt M., Marrie T. J., Etienne J., Cosserat J., Cacoub P., Poinsignon Y., Leclercq P. et al. 1996; Diagnosis of 22 new cases of Bartonella endocarditis. Ann Intern Med 125:646–652[PubMed] [CrossRef]
    [Google Scholar]
  16. Raoult D., Fournier P. E., Vandenesch F., Mainardi J. L., Eykyn S. J., Nash J., James E., Benoit-Lemercier C., Marrie T. J. 2003; Outcome and treatment of Bartonella endocarditis. Arch Intern Med 163:226–230 [View Article][PubMed]
    [Google Scholar]
  17. Regnery R. L., Spruill C. L., Plikaytis B. D. 1991; Genotypic identification of rickettsiae and estimation of intraspecies sequence divergence for portions of two rickettsial genes. J Bacteriol 173:1576–1589[PubMed]
    [Google Scholar]
  18. Rolain J. M., Brouqui P., Koehler J. E., Maguina C., Dolan M. J., Raoult D. 2004; Recommendations for Treatment of Human Infections Caused by Bartonella Species. Antimicrobial Agents and Chemotherapy 48:1921–1933 [View Article]
    [Google Scholar]
  19. Spach D. H., Callis K. P., Paauw D. S., Houze Y. B., Schoenknecht F. D., Welch D. F., Rosen H., Brenner D. J. 1993; Endocarditis caused by Rochalimaea quintana in a patient infected with human immunodeficiency virus. J Clin Microbiol 31:692[PubMed]
    [Google Scholar]
  20. Vikram H. R., Bacani A. K., DeValeria P. A., Cunningham S. A., Cockerill F. R. 2007; Bivalvular Bartonella henselae prosthetic valve endocarditis. J Clin Microbiol 45:4081–4084 [View Article][PubMed]
    [Google Scholar]
  21. Weisburg W. G., Barns S. M., Pelletier D. A., Lane D. J. 1991; 16S ribosomal DNA amplification for phylogenetic study. J Bacteriol 173:697–703[PubMed]
    [Google Scholar]
  22. Wiegand G., Remington S. J. 1986; Citrate synthase: structure, control, and mechanism. Annu Rev Biophys Biophys Chem 15:97–117 [View Article][PubMed]
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmmcr/10.1099/jmmcr.0.005049
Loading
/content/journal/jmmcr/10.1099/jmmcr.0.005049
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error