Bartonella as a cause of blood culture-negative endocarditis. Description of five cases.

There is evidence that Bartonella is an etiologic factor in human endocarditis. The objective of this article was to describe cases of endocarditis due to Bartonella observed at a tertiary-care hospital during 1995-2006. Overall, 140 cases of infective endocarditis were seen, of which 10 were blood culture-negative endocarditis, with five being due to Bartonella. In four cases, there had been contact with cats. Only two patients had pre-existing cardiac valvular disease. Three had extracardiac disease manifestations. In three cases, polymerase chain reaction (PCR) tests on cardiac valvular tissue gave positive results. Two patients had positive serology test results for Chlamydophila and another two, positive results for Coxiella burnetii. All five patients needed surgery, and the outcome was favorable in all five. The presence of Bartonella must be considered in patients with blood culture-negative endocarditis. Although serological testing is essential for the diagnosis, cross-reactions between Bartonella and C. burnetii or Chlamydophila are frequent, and PCR tests on cardiac valvular tissue, therefore, play an important diagnostic role.

Bartonella como causa de endocarditis con hemocultivos negativos. Descripción de 5 casos / Bartonella as a cause of blood culture-negative endocarditis. Description of Five cases

Bartonella está implicada como agente etiológico de la endocarditis en humanos. El objetivo del artículo es describir los casos de endocarditis por Bartonella diagnosticados en un hospital de tercer nivel durante el periodo 1995-2006. Hubo 140 casos de endocarditis infecciosa, de los cuales 10 cursaron con hemocultivos negativos (5 por Bartonella). Se había producido contacto con gatos en 4 casos; sólo 2 pacientes presentaban valvulopatía previa; 3 tuvieron clínica extracardiaca; en 3 se realizó PCR de tejido valvular, con resultado positivo; 2 pacientes tenían además serología positiva para Chlamydophila y otros dos, para Coxiella burnetii. Los 5 precisaron tratamiento quirúrgico. La evolución fue favorable en todos. Se debe sospechar infección por Bartonella ante un paciente con endocarditis y hemocultivos negativos. La serología es fundamental para el diagnóstico, pero es habitual encontrar reacciones cruzadas entre Bartonella y C. burnetti o Chlamydophila, por lo que la PCR del tejido es importante para el diagnóstico (AU)

There is evidence that Bartonella is an etiologic factor in human endocarditis. The objective of this article was to describe cases of endocarditis due to Bartonella observed at a tertiary-care hospital during 1995-2006. Overall, 140 cases of infective endocarditis were seen, of which 10 were blood culture-negative endocarditis, with five being due to Bartonella. In four cases, there had been contact with cats. Only two patients had pre-existing cardiac valvular disease. Three had extracardiac disease manifestations. In three cases, polymerase chain reaction (PCR) tests on cardiac valvular tissue gave positive results. Two patients had positive serology test results for Chlamydophila and another two, positive results for Coxiella burnetii. All five patients needed surgery, and the outcome was favorable in all five. The presence of Bartonella must be considered in patients with blood culture-negative endocarditis. Although serological testing is essential for the diagnosis, cross-reactions between Bartonella and C. burnetii or Chlamydophila are frequent, and PCR tests on cardiac valvular tissue, therefore, play an important diagnostic role (AU)

[Amoebic liver abscess: observations in seven patients]. / Absceso hepático amebiano: observaciones sobre siete pacientes.

INTRODUCTION: The epidemiological and clinical characteristics of patients with amoebic liver abscess are described. METHODS: Laboratory, clinical, and epidemiological records of all patients with amoebic liver abscess diagnosed from 1991 to 2002 at Hospital Universitario Son Dureta (Palma de Mallorca, Spain), a 980-bed referral hospital in the Balearic Islands, were retrospectively reviewed. RESULTS: Seven patients were diagnosed with amoebic liver abscesses and all were residing in Mallorca. Two patients had developed the disease after travelling to endemic areas (India and Thailand), and another, from Ecuador, had been diagnosed four months after coming to Spain from his country of origin. In the remaining four patients, no apparent link with endemic areas was observed, nor was travel out of Spain recorded. Therefore, these cases were thought to have originated in Spain, though this circumstance could not be conclusively proven. Two of the seven patients had human inmunodeficiency virus (HIV) infection. CONCLUSIONS: An amoebic etiology should be considered in the differential diagnosis of liver abscess in our area, even in the absence of a clear related epidemiological history.

Endocarditis por Bartonella en un paciente con infección por el virus de la inmunodeficiencia humana / Endocarditis by Bartonella in a patient with human immunodeficiency virus infection

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