Culture-negative Bartonella endocarditis in a patient with renal failure: the value of molecular methods in diagnosis.
Members of the genus Bartonella are increasingly recognised as a cause of culture-negative endocarditis, particularly in those patients with underlying risk factors (e.g., homelessness and alcoholism (B. quintana) or valvulopathy and cat ownership (B. henselae). The aortic and mitral-valves are most commonly involved. Here, a case is reported of culture-negative right-sided endocarditis, without any of the above risk factors, due to Bartonella sp. in a 69-year-old man who presented with acute renal failure. The diagnosis was made using a broad-range 16S rRNA polymerase chain reaction (PCR) technique and direct automated sequencing on a peripheral blood sample, which was subsequently confirmed serologically. A review of the literature on Bartonella endocarditis is also presented. Molecular laboratory methods using peripheral blood or blood cultures may be very useful in the diagnosis of causal agents in culture-negative endocarditis and add further support to the recently inclusion of molecular (PCR) diagnosis, as a major Duke's criterion, for the diagnosis of infective endocarditis.
Todd
S
S
Directorate of Nephrology, Belfast City Hospital, Belfast, Northern Ireland.
Xu
J
J
Millar
B C
BC
Moore
J E
JE
Crowe
M
M
Raoult
D
D
Harrison
T
T
Hill
C
C
Douglas
J
J
D058186:Acute Kidney Injury / Q000150:complications* / Q000382:microbiology; D000368:Aged; D001474:Bartonella Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D004697:Endocarditis, Bacterial / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D008297:Male; D016133:Polymerase Chain Reaction / Q000379:methods; D012329:RNA, Bacterial / Q000032:analysis; D012336:RNA, Ribosomal, 16S / Q000032:analysis
D012329:RNA, Bacterial; D012336:RNA, Ribosomal, 16S