Bartonella quintana Endocarditis Complicated by Cerebral Stroke: A Case Report

Bartonella quintana is rarely associated with neurological manifestations. This report describes a rare case of endocarditis complicated by a cerebral stroke caused by B. quintana. We also briefly reviewed the neurological clinical spectrum of B. quintana disease described in the literature. Serology tests were performed using the VIRCLIA®-system (chemiluminescence assay, Vircell, Spain) and immunofluorescence assay (IFA; Focus Diagnostics, USA). Cerebrospinal fluid (CSF) was tested using the BioFire-CSF-FilmArray-Meningitis/Encephalitis Panel (bioMérieux, France). CSF, plasma, and biopsy samples were tested using Bartonella-qPCR combined with Sanger-sequencing. A 23-year-old male Afghan refugee residing in Belgium presented with persistent fatigue and cough. A calcified aortic bicuspid with severe insufficiency and moderately associated stenosis was diagnosed. A transesophageal echocardiogram revealed a shrinking valve and a mobile mass attached to the calcification of the free edge at the aorta. He developed fever, a moderate inflammatory syndrome with normocytic anemia, and renal failure with hematuria and proteinuria, indicating probable glomerulonephritis. He met the Duke criteria for infective endocarditis, though blood cultures were initially negative. Bartonella serology later returned positive. He developed a fever and intense headache. CSF showed moderate pleiocytosis, but a negative-FilmArray. Neurovascular MR-angiography revealed a multifocal ischemic stroke. His aortic valve was replaced (Ross procedure). The biopsy showed nodular and degenerative fibro-calcified rearrangements. B.  quintana presence was confirmed in CSF, blood, and mitral valve samples. Our report underlines that B. quintana is a rare but a possible cause of endocarditis and neurological damage, and emphasizes the need for effective healthcare access, which is often limited in the countries of origin of migrants and even for migrants residing in high-resource countries.