Correspondence

Bartonella quintana Endocarditis in a Child

N Engl J Med 2000; 342:1841-1842June 15, 2000

Article

To the Editor:

Blood-culture–negative endocarditis has been described in about 12 percent of children with endocarditis.1 Because of recent diagnostic advances, some of the pathogens responsible for these cases have been identified.

A 13-year-old girl from Senegal was referred to our center for surgical treatment of rheumatic heart disease, which had been diagnosed when she was 8 years of age. She lived in a large city in a stable environment, did not abuse drugs, and had no close contact with cats. At admission, she was in good general condition and had no signs of intercurrent infection, fever, or lymphadenopathy. The echocardiography confirmed the presence of mitral and aortic regurgitations and also revealed several prominent vegetations attached to the anterior and posterior mitral-valve leaflets, the left-sided interventricular septum, and the right coronary cusp of the aortic valve. The aortic valve was replaced by a homograft, the mitral valve was repaired, and the vegetations were resected. All seven sets of blood cultures (five venous and two arterial) obtained preoperatively remained negative after incubation for five days. Therefore, no antibiotic therapy was initiated.

The excised valve tissue was cultured, but the culture remained negative. A broad-range polymerase-chain-reaction (PCR) amplification of part of the 16S ribosomal RNA gene was performed on the excised valve tissue.2 A 439-bp sequence was compared with sequences of bacterial 16S ribosomal RNA genes deposited in GenBank and the European Molecular Biology Laboratory data base, and the sequence was found to be 100 percent homologous to the reference sequence of Bartonella quintana. Analyses of the patient's serum samples showed IgG and IgM antibody titers to B. quintana of 1:4096 and 1:320, respectively, and the samples cross-reacted with B. henselae. Other serologic analyses showed a previous infection with Chlamydia psittaci or Chlamydia pneumoniae and no previous contact with Coxiella burnetii. The child had an uneventful postoperative course. Intravenous treatment with doxycycline (2 mg per kilogram of body weight per day) and gentamicin (5 mg per kilogram per day) was given for four weeks and resulted in a reduction in antibody titers.3

B. quintana endocarditis was first described in 1993 in a patient infected with the human immunodeficiency virus (HIV).4 Since then, several cases have been reported, mostly in patients who were homeless, alcoholic, intravenous drug abusers, or HIV-positive, and the cases were diagnosed on the basis of results on blood cultures after prolonged incubation and serologic findings.5 Reports outside those risk groups are rare, and, to our knowledge, we describe the first case of B. quintana endocarditis in a child.

In conclusion, B. quintana endocarditis may occur in children and thus should be searched for in children with blood-culture–negative endocarditis. In addition to methods of identification of the organism that involve prolonged incubation of blood cultures and serologic analysis, PCR of tissue fragments of vegetations is also a promising tool.

Klara Pósfay Barbe, M.D.
Edgar Jaeggi, M.D.
Béatrice Ninet
Nadia Liassine, M.D.
Cosima Donatiello, M.D.
Alain Gervaix, M.D.
Susanne Suter, M.D.
Hôpitaux Universitaires de Genève, 1211 Geneva 14, Switzerland

5 References

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   Full Text | Web of Science | Medline

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Citing Articles (4)

Citing Articles

1. 1

   Bibhuti B. Das, Emily Wasser, Kristina A. Bryant, Charles R. Woods, Song-Gui Yang, Matt Zahn. (2009) CULTURE NEGATIVE ENDOCARDITIS CAUSED BY BARTONELLA HENSELAE IN A CHILD WITH CONGENITAL HEART DISEASE. The Pediatric Infectious Disease Journal 28:10, 922-925
   CrossRef

2. 2

   Jens Dreier, Tanja Vollmer, Claudia Christine Freytag, Dietrich Bäumer, Reiner Körfer, Knut Kleesiek. (2008) Culture-negative infectious endocarditis caused by Bartonella spp.: 2 case reports and a review of the literature. Diagnostic Microbiology and Infectious Disease 61:4, 476-483
   CrossRef

3. 3

   Clovis W. Pitchford, C. Buddy Creech, Timothy R. Peters, Cindy L. Vnencak-Jones. (2006) Bartonella henselae Endocarditis in a Child. Pediatric Cardiology 27:6, 769-771
   CrossRef

4. 4

   PIERRE-EDOUARD FOURNIER, HERVÉ LELIEVRE, SUSANNAH J. EYKYN, JEAN-LUC MAINARDI, THOMAS J. MARRIE, FABRICE BRUNEEL, CHANTAL ROURE, JAMES NASH, DANIÈLE CLAVE, EDWARD JAMES, CATHERINE BENOIT-LEMERCIER, LIONEL DEFORGES, HERVÉ TISSOT-DUPONT, DIDIER RAOULT. (2001) Epidemiologic and Clinical Characteristics of Bartonella quintana and Bartonella henselae Endocarditis. Medicine 80:4, 245-251
   CrossRef