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Case Reports
. 2016 Aug 30;3(4):e005049.
doi: 10.1099/jmmcr.0.005049. eCollection 2016 Aug.

Case series of Bartonella quintana blood culture-negative endocarditis in Washington, DC

Fisseha Y Ghidey  1 , Osamuyimen Igbinosa  1 , Kristin Mills  1 , Leon Lai  1 , Christian Woods  1 , Maria E Ruiz  1 , Dawn Fishbein  1 , Rahul Sampath  2 , Robert Lowery  1 , Glenn Wortmann  1
Affiliations
Case Reports

Case series of Bartonella quintana blood culture-negative endocarditis in Washington, DC

Fisseha Y Ghidey et al. JMM Case Rep. .

Abstract

Introduction: Prior studies (predominantly from Europe) have demonstrated blood culture-negative endocarditis due to Bartonella. Our objective was to describe three cases of Bartonella quintana 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 Bartonella quintana serum immunoglobulin G (IgG) with negative immunoglobulin M (IgM). PCR on DNA extracted from cardiac valves was positive for Bartonella, and DNA sequencing of PCR amplicons identified Bartonella quintana. Patients received treatment with doxycycline/rifampin or doxycycline/gentamicin.

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

Keywords: endocarditis; Bartonella quintana; Culture-negative.

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