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[Subacute infectious endocarditis due to the agent of cat scratch fever: Bartonella henselae]
A Grand1, M Celard, R el Belghiti
1Service de cardiologie, centre hospitalier de Valence, 26953 Valence.
Insights
A cat owner with severe mitral stenosis was diagnosed with Bartonella Henselae infectious endocarditis (IE). Early diagnosis via serology and genetic amplification led to successful treatment and a good prognosis.
Area of Science:
- Infectious Diseases
- Cardiology
- Microbiology
Background:
- Infectious endocarditis (IE) is a serious infection of the heart valves.
- Bartonella Henselae is a rare cause of IE, typically affecting the aortic valve and causing large vegetations.
- Diagnosis can be challenging, especially in culture-negative cases.
Observation:
- A 48-year-old immunocompetent male cat owner presented with severe mitral stenosis and a left atrial mass, initially suspected as thrombus.
- The mass was identified as an infective endocarditis vegetation.
- Blood and valve cultures were negative, but serological testing and genetic amplification confirmed Bartonella Henselae infection.
Findings:
- The patient received 6 months of antibiotic therapy and underwent valve replacement.
- Bartonella Henselae IE is rare, with most cases involving the aortic valve and potential for systemic emboli.
- Genetic amplification and serology are crucial for diagnosing Bartonella Henselae IE, especially in blood culture-negative endocarditis.
Implications:
- Sero-diagnosis of Bartonellosis should be considered in all blood culture-negative IE cases.
- Early and accurate diagnosis of Bartonella Henselae IE leads to effective treatment and good patient outcomes.
- This case highlights the importance of considering zoonotic infections in IE diagnosis.
Abstract:
The diagnosis of severe mitral stenosis with left atrial thrombus was rectified at valvular replacement in a 48-year old immuno-competent man who was a cat owner. The mass in the left atrium was, in fact, a large endocarditic vegetation. Pre- and postoperative blood cultures were negative as was culture of the excised mitral valve. The diagnosis of infectious endocarditis (IE) due to Bartonella Henselae was made from a positive serological test (1600) and identification of the germ by genetic amplification. Antibiotic therapy was continued for 6 months and the patient was cured with a follow-up of 4 years. Bartonella Henselae IE is very rare (14 reported cases) and affects mainly the aortic valve, often giving rise to very large vegetations which, in half the cases, are complicated by systemic emboli. Germs like Batonella are sensitive to most antibiotics, especially the aminosides and macrolides. In Bartonella Henselae IE, valve replacement is the rule (13 out of 14 cases) and the prognosis is usually good. Sero-diagnosis of Bartonellosis should be part of the systematic investigation of all blood culture negative IE.