Zusammenfassung
Die Kultur-negative Endokarditis (2,5–31% aller Endokarditis-Fälle) bleibt eine diagnostische und therapeutische Herausforderung. Bartonella spp. wurde erst kürzlich als wichtige Ursache von Kultur-negativer Endokarditis erkannt. Wir berichten über einen Fall mit Bartonella henselae Endokarditis, die bei einem immunkompetenten Mann auftrat, der eine Katze besaß und bei dem früher ein Klappenvitium diagnostiziert worden war. Die Diagnose konnte erst nach langwieriger diagnostischer Aufarbeitung von serologischen Untersuchungen und Identifikation des Mikroorganismus in den exzidierten Klappen durch PCR und konsekutive Sequenzierung erstellt werden. Die Therapiedauer ist für Patienten mit Bartonella Endokarditis nicht klar definiert. Wir entschieden uns für eine länger dauernde Antibiotikatherapie. Eine operative Sanierung ist bei diesen Endokarditiden häufig notwendig – wie auch bei unserem Patienten, bei dem sie erfolgreich durchgeführt werden konnte. Soweit wir wissen, handelt es sich hier um den ersten Fall einer durch Bartonella ausgelösten Endokarditis in unserer Region.
Summary
Culture-negative endocarditis accounts for 2.5–31% of all endocarditis cases and remains a diagnostic and therapeutic challenge. Bartonella spp. has only recently been recognized as an important cause of culture-negative endocarditis. We report a case of Bartonella henselae endocarditis occurring in an immunocompetent man who owned a cat and had previously been diagnosed with valvulopathy. Diagnosis was made only after prolonged diagnostic work-up with serology and with PCR and subsequent sequencing to identify the microorganism in the excised valves. The duration of treatment in patients with bartonella endocarditis is not clearly defined, and we decided to treat our patient with a prolonged course of antibiotic. Surgical treatment is usually necessary and was also successful in our patient. To our knowledge, this is the first case of bartonella endocarditis occurring in our geographic area.
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Lejko-Zupanc, T., Slemenik-Pušnik, C., Koželj, M. et al. Native valve endocarditis due to Bartonella henselae in an immunocompetent man. Wien Klin Wochenschr 120, 246–249 (2008). https://doi.org/10.1007/s00508-008-0951-3
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DOI: https://doi.org/10.1007/s00508-008-0951-3