Infective endocarditis due to Bartonella spp. and Coxiella burnetii: experience at a cardiology hospital in Sao Paulo, Brazil

Bartonella spp. and Coxiella burnetii are recognized as causative agents of blood culture-negative endocarditis (BCNE) in humans and there are no studies of their occurrences in Brazil. The purpose of this study is to investigate Bartonella spp. and C. burnetii as a causative agent of culture-negati...

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Bibliographic Details
Published in:Annals of the New York Academy of Sciences 2006-10, Vol.1078 (1), p.215-222
Main Authors: Siciliano, Rinaldo Focaccia, Strabelli, Tânia Mara, Zeigler, Rogério, Rodrigues, Cristhieni, Castelli, Jussara Bianchi, Grinberg, Max, Colombo, Silvia, da Silva, Luiz Jacintho, Mendes do Nascimento, Elvira Maria, Pereira dos Santos, Fabiana Cristina, Uip, David Everson
Format: Article
Language:English
Subjects:
Adult
Antibodies, Bacterial - blood
Aortic Valve - microbiology
Aortic Valve - pathology
Bartonella
Bartonella henselae
Bartonella Infections - diagnosis
Coxiella burnetii
Diagnosis, Differential
Endocarditis, Bacterial - microbiology
Female
Humans
Immunoglobulin G - blood
Male
Middle Aged
Q Fever - diagnosis
Retrospective Studies
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Summary:Bartonella spp. and Coxiella burnetii are recognized as causative agents of blood culture-negative endocarditis (BCNE) in humans and there are no studies of their occurrences in Brazil. The purpose of this study is to investigate Bartonella spp. and C. burnetii as a causative agent of culture-negative endocarditis patients at a cardiology hospital in São Paulo, Brazil. From January 2004 to December 2004 patients with a diagnosis of endocarditis at our Institute were identified and recorded prospectively. They were considered to have possible or definite endocarditis according to the modified Duke criteria. Those with blood culture-negative were tested serologically using the indirect immunofluorescent assay (IFA) for Bartonella henselae, B. quintana, and C. burnetii. IFA-IgG titers >800 for Bartonella spp. and C. burnetii were considered positive. A total of 61 patients with endocarditis diagnosis were evaluated, 17 (27%) were culture-negative. Two have had IgG titer greater than 800 (>/=3,200) against Bartonella spp. and one against C. burnetii (phase I and II>/=6,400). Those with Bartonella-induced endocarditis had a fatal disease. Necropsy showed calcifications and extensive destruction of the valve tissue, which is diffusely infiltrated with mononuclear inflammatory cells predominantly by foamy macrophages. The patient with C. burnetii endocarditis received specific antibiotic therapy. Reports of infective endocartitis due to Bartonella spp. and C. burnetii in Brazil reveal the importance of investigating the infectious agents in culture-negative endocarditis.
ISSN:0077-8923
1749-6632
DOI:10.1196/annals.1374.123