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Blood culture-negative endocarditis caused by Bartonella henselae: a case report

Tsukasa Ohno1, Shunei Saito1, Eri Iwata2

  • 1Division of Cardiovascular Surgery, Ichinomiya Municipal Hospital, 2-2-22 Bunkyo, Ichinomiya, Aichi 491-8558 Japan.

Indian Journal of Thoracic and Cardiovascular Surgery
|November 10, 2021
PubMed

Insights

Bartonella henselae can cause infective endocarditis, a rare heart infection. Diagnosis is challenging, but PCR on valve tissue confirmed the organism in a patient with cat scratch disease symptoms.

Area of Science:

  • Infectious Diseases
  • Cardiology
  • Microbiology

Background:

  • Bartonella henselae is the primary cause of cat scratch disease.
  • Cardiac involvement by Bartonella henselae is infrequent and diagnostically challenging.

Observation:

  • A 75-year-old woman with a pet cat presented with pancytopenia, hepatosplenomegaly, and low-grade fever.
  • Echocardiography revealed sessile nodules on the aortic valve.
  • Standard blood cultures and C-reactive protein levels were non-diagnostic.

Findings:

  • Elevated Bartonella henselae immunoglobulin G titers suggested infective endocarditis.
  • Polymerase chain reaction (PCR) testing of excised aortic valve tissue confirmed Bartonella henselae DNA.
  • Initial antimicrobial treatment included minocycline and gentamicin, followed by aortic valve replacement.

Implications:

  • This case highlights the importance of considering Bartonella henselae in culture-negative endocarditis, especially in patients with relevant exposure.
  • Advanced molecular techniques like PCR are crucial for diagnosing challenging Bartonella henselae infections.
  • Successful management involved a combination of antibiotics and surgical intervention.

Keywords:
Aortic valveBartonella henselaeEndocarditisPolymerase chain reactionSerology

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