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Bartonella quintana pulmonary native valve endocarditis

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Indian Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Bartonella quintana is a well-known cause of blood culture-negative endocarditis; however, pulmonary valve involvement is rare. The case of a 40-year-old African male who presented to the Emergency Department with chest pain, cardiac failure, and a 2-week history of fever is presented. Transoesophageal echocardiography confirmed an atrial septal defect, severe pulmonary insufficiency with large vegetations, severe mitral regurgitation due to anterior leaflet prolapse, and right ventricular dysfunction. Empirical antibiotic therapy was started, and urgent surgical intervention was decided. There were vegetations on the three pulmonary valve leaflets and the mitral valve. Closure of the atrial septal defect, mitral and tricuspid valve repair, pulmonary valve replacement with a biological prosthesis, and infundibuloplasty of the right ventricle were performed. The postoperative course was uneventful. Preoperative blood cultures were negative, and B. quintana was detected through 16S rRNA gene amplification and sequencing in mitral and pulmonary implants. Serology showed positive titers of 1/1260 for both B. quintana and B. henselae. Ceftriaxone and gentamicin were administered for 10 days, followed by oral doxycycline for 12 weeks. A one-year echocardiogram showed normal functioning of the pulmonary prosthesis and the mitral and tricuspid repair. Infection caused by B. quintana is a rare cause of endocarditis with negative blood cultures, and multivalvular and pulmonary valve involvement is exceptional.

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Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Cardiovascular Surgery Department, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Spain

    Ramón Aranda-Domene, Elena Sandoval & Eduard Quintana

  2. Department of Infectious Diseases, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Spain

    Guillermo Cuervo

  3. Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain

    Guillermo Cuervo

  4. Department of Microbiology, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Spain

    Mariana Fernández-Pittol

  5. Infectious Diseases Department, Hospital Clínic-FCRB-IDIBAPS, University of Barcelona, Barcelona, Spain

    Cristina García de la María

Authors
  1. Ramón Aranda-Domene
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  2. Elena Sandoval
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  3. Guillermo Cuervo
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  4. Mariana Fernández-Pittol
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  5. Cristina García de la María
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  6. Eduard Quintana
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Contributions

Conceptualization: RA, EQ; formal analysis and investigation: RA, ES, GC, MF, CG, EQ; writing—original draft preparation: RA, EQ; writing—review and editing: RA, ES, GC, MF, CG, EQ; supervision: EQ.

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Correspondence to Eduard Quintana.

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Supplementary Information

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Supplementary file1 (MOV 163762 KB) Video 1: Preoperative Transoesophageal echocardiography.

Supplementary file2 (MP4 293023 KB) Video 2: Intraoperative mitral valve assessment.

Supplementary file3 (MP4 160715 KB) Video 3: Intraoperative pulmonary valve assessment.

Supplementary file4 (MP4 45211 KB) Video 4: Follow-up transthoracic echocardiography one year after the surgical procedure.

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Aranda-Domene, R., Sandoval, E., Cuervo, G. et al. Bartonella quintana pulmonary native valve endocarditis. Indian J Thorac Cardiovasc Surg (2024). https://doi.org/10.1007/s12055-024-01727-4

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  • DOI: https://doi.org/10.1007/s12055-024-01727-4

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