Skip to main content
SpringerLink
Log in

Rezidivierende intrazerebrale Blutungen bei einer 24-jährigen Patientin

Recurrent intracerebral haemorrhage in a 24-year-old female patient

Der Internist Aims and scope Submit manuscript

Cite this article

Zusammenfassung

Eine 24-jährige Patientin aus Sierra Leone wurde nach unklaren intrazerebralen Blutungsereignissen und einer echoreichen Auflagerung an der Aortenklappe vorstellig. Die Patientin war bei paroxysmalem Vorhofflimmern und Non-compaction-Kardiomyopathie antikoaguliert. In der weiteren Diagnostik gelang durch Fluoreszenz-in-situ-Hybridisierung in Kombination mit Polymerase-Kettenreaktion und Sequenzierung der Nachweis einer durch Bartonella quintana verursachten Mitral- und Aortenklappenendokarditis. Retrospektiv waren die intrazerebralen Hämorrhagien als septische Embolien mit sekundärer Einblutung unter neuen oralen Antikoagulanzien zu werten. Nach biologischem Mitral- und Aortenklappenersatz sowie mehrwöchiger Doxycyclin- und Gentamicingabe zeigte sich die Patientin in ihren Beschwerden deutlich gebessert und ohne weitere Blutungsereignisse.

Abstract

A 24-year-old female patient from Sierra Leone was referred to the authorsʼ hospital after several unclear intracerebral bleeding events and an echogenic structure on the aortic valve. The patient was receiving oral anticoagulation therapy due to paroxysmal atrial fibrillation and left ventricular noncompaction. Fluorescence in situ hybridization in combination with polymerase chain reaction and sequencing revealed infective endocarditis of the mitral and aortic valve caused by Bartonella quintana. In retrospect, the intracerebral bleeding events could be identified as septic emboli with secondary haemorrhagic transformation under anticoagulation therapy. The patient showed significant clinical improvement and no further bleeding events occurred after receiving biological mitral and aortic valve replacement and several weeks of doxycycline and gentamicin antibiotic therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Literatur

  1. Angelakis E, Raoult D (2014) Pathogenicity and treatment of Bartonella infections. Int J Antimicrob Agents 44:16–25

    Article  CAS  PubMed  Google Scholar 

  2. Baddour LM, Wilson WR, Bayer AS et al (2005) Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. Circulation 111:e394–e434

    Article  PubMed  Google Scholar 

  3. Brouqui P, Lascola B, Roux V et al (1999) Chronic Bartonella quintana bacteremia in homeless patients. N Engl J Med 340:184–189

    Article  CAS  PubMed  Google Scholar 

  4. Attenhofer-Jost CH (2019) Isolated left ventricular noncompaction in adults: management and prognosis. UpToDate, Waltham (https://www.uptodate.com)

    Google Scholar 

  5. Spach DH (2019) Endocarditis caused by Bartonella. UpToDate, Waltham (https://www.uptodate.com)

    Google Scholar 

  6. Edouard S, Nabet C, Lepidi H et al (2015) Bartonella, a common cause of endocarditis: a report on 106 cases and review. J Clin Microbiol 53:824–829

    Article  PubMed  PubMed Central  Google Scholar 

  7. Eichinger S, Kikhney J, Moter A et al (2019) Fluorescence in situ hybridization for identification and visualization of microorganisms in infected heart valve tissue as addition to standard diagnostic tests improves diagnosis of endocarditis. Interact CardioVasc Thorac Surg 29:678–684

    Article  PubMed  Google Scholar 

  8. Foucault C, Brouqui P, Raoult D (2006) Bartonella quintana characteristics and clinical management. Emerging Infect Dis 12:217–223

    Article  Google Scholar 

  9. Gauduchon V, Chalabreysse L, Etienne J et al (2003) Molecular diagnosis of infective endocarditis by PCR amplification and direct sequencing of DNA from valve tissue. J Clin Microbiol 41:763–766

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Geissdörfer W, Moos V, Moter A et al (2012) High frequency of Tropheryma whipplei in culture-negative endocarditis. J Clin Microbiol 50:216–222

    Article  PubMed  PubMed Central  Google Scholar 

  11. Gescher DM, Mallmann C, Kovacevic D et al (2008) A view on Bartonella quintana endocarditis—confirming the molecular diagnosis by specific fluorescence in situ hybridization. Diagn Microbiol Infect Dis 60:99–103

    Article  CAS  PubMed  Google Scholar 

  12. Jacomo V, Kelly PJ, Raoult D (2002) Natural history of Bartonella infections (an exception to Koch’s postulate). Clin Diagn Lab Immunol 9:8–18

    CAS  PubMed  PubMed Central  Google Scholar 

  13. Karem KL, Paddock CD, Regnery RL (2000) Bartonella henselae, B. quintana, and B. bacilliformis: historical pathogens of emerging significance. Microbes Infect 2:1193–1205

    Article  CAS  PubMed  Google Scholar 

  14. Minnick MF, Battisti JM (2009) Pestilence, persistence and pathogenicity: infection strategies of Bartonella. Future Microbiol 4:743–758

    Article  PubMed  Google Scholar 

  15. Moter A, Musci M, Schmiedel D (2010) Molecular methods for diagnosis of infective endocarditis. Curr Infect Dis Rep 12:244–252

    Article  PubMed  Google Scholar 

  16. Mylonakis E, Calderwood SB (2001) Infective endocarditis in adults. N Engl J Med 345:1318–1330

    Article  CAS  PubMed  Google Scholar 

  17. Raoult D, Fournier PE, Vandenesch F et al (2003) Outcome and treatment of Bartonella endocarditis. Arch Intern Med 163:226–230

    Article  PubMed  Google Scholar 

  18. Schulein R, Seubert A, Gille C et al (2001) Invasion and persistent intracellular colonization of erythrocytes: a unique parasitic strategy of the emerging pathogen Bartonella. J Exp Med 193:1077–1086

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Tanaka H, Kimura T, Miyamoto S (2014) Aortic valve replacement for aortic regurgitation with rare left ventricular non-compaction. Ann Thorac Cardiovasc Surg 20:76–79

    Article  PubMed  Google Scholar 

  20. Werner M, Andersson R, Olaison L et al (2003) A clinical study of culture-negative endocarditis. Medicine 82:263–273

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Medizinische Klinik – Innere Medizin, Klinikum Füssen, Kliniken Ostallgäu-Kaufbeuren, Stadtbleiche 1, 87629, Füssen, Deutschland

    S. Hipp, W. von der Emde & M. Hinterseer

  2. Herzzentrum Füssen-Außerfern, Klinikum Füssen, Füssen, Deutschland

    S. Hipp & M. Hinterseer

  3. Radiologische Praxis Dr. Bauer & Kollegen, Füssen, Deutschland

    C. Kulke

  4. Klinik für Neurologie, BKH Kaufbeuren, Kaufbeuren, Deutschland

    M. Schlotter

  5. m&i-Fachklinik Enzensberg, Hopfen am See, Deutschland

    J. Schmidt

  6. Institute for Microbiology, Infectious Diseases, and Immunology, Biofilmcenter, Charité – University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland

    J. Kikhney, A. G. M. Hopf & A. Moter

  7. MoKi Analytics GmbH, Marienplatz 9, 12207, Berlin, Deutschland

    J. Kikhney & A. Moter

  8. Moter Diagnostics, Marienplatz 9, 12207, Berlin, Deutschland

    A. Moter

  9. Klinik für Herzchirurgie, München Klinik Bogenhausen, München, Deutschland

    E. Eszlari & W. Eichinger

Authors
  1. S. Hipp
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. W. von der Emde
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Kulke
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Schlotter
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. Schmidt
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. Kikhney
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. A. G. M. Hopf
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. A. Moter
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. E. Eszlari
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. W. Eichinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. M. Hinterseer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. Hipp.

Ethics declarations

Interessenkonflikt

S. Hipp, W. von der Emde, C. Kulke, M. Schlotter, J. Schmidt, J. Kikhney, A.G.M. Hopf, A. Moter, E. Eszlari, W. Eichinger und M. Hinterseer geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien. Für Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts, über die Patienten zu identifizieren sind, liegt von ihnen und/oder ihren gesetzlichen Vertretern eine schriftliche Einwilligung vor.

Additional information

Redaktion

H. Haller, Hannover (Schriftleitung)

B. Salzberger, Regensburg

C.C. Sieber, Nürnberg

figure qr

QR-Code scannen & Beitrag online lesen

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hipp, S., von der Emde, W., Kulke, C. et al. Rezidivierende intrazerebrale Blutungen bei einer 24-jährigen Patientin. Internist 63, 103–109 (2022). https://doi.org/10.1007/s00108-021-01157-z

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00108-021-01157-z

Schlüsselwörter

Keywords

search

Navigation