title: Infective endocarditis due to Bartonella spp. and Coxiella burnetii: experience at a cardiology hospital in Sao Paulo, Brazil.
abstract: Bartonella spp. and Coxiella burnetii are recognized as causative agents of blood culture-negative endocarditis (BCNE) in humans and there are no studies of their occurrences in Brazil. The purpose of this study is to investigate Bartonella spp. and C. burnetii as a causative agent of culture-negative endocarditis patients at a cardiology hospital in São Paulo, Brazil. From January 2004 to December 2004 patients with a diagnosis of endocarditis at our Institute were identified and recorded prospectively. They were considered to have possible or definite endocarditis according to the modified Duke criteria. Those with blood culture-negative were tested serologically using the indirect immunofluorescent assay (IFA) for Bartonella henselae, B. quintana, and C. burnetii. IFA-IgG titers >800 for Bartonella spp. and C. burnetii were considered positive. A total of 61 patients with endocarditis diagnosis were evaluated, 17 (27%) were culture-negative. Two have had IgG titer greater than 800 (>/=3,200) against Bartonella spp. and one against C. burnetii (phase I and II>/=6,400). Those with Bartonella-induced endocarditis had a fatal disease. Necropsy showed calcifications and extensive destruction of the valve tissue, which is diffusely infiltrated with mononuclear inflammatory cells predominantly by foamy macrophages. The patient with C. burnetii endocarditis received specific antibiotic therapy. Reports of infective endocartitis due to Bartonella spp. and C. burnetii in Brazil reveal the importance of investigating the infectious agents in culture-negative endocarditis.
authors.affiliation: Rua Cardoso de Almeida 1006/apto13, Perdizes, São Paulo/Brazil CEP 05013-001. rinaldo_focaccia@uol.com.br
authors.forename: Rinaldo Focaccia
authors.initials: RF
authors.lastname: Siciliano
authors.forename: Tânia Mara
authors.initials: TM
authors.lastname: Strabelli
authors.forename: Rogério
authors.initials: R
authors.lastname: Zeigler
authors.forename: Cristhieni
authors.initials: C
authors.lastname: Rodrigues
authors.forename: Jussara Bianchi
authors.initials: JB
authors.lastname: Castelli
authors.forename: Max
authors.initials: M
authors.lastname: Grinberg
authors.forename: Silvia
authors.initials: S
authors.lastname: Colombo
authors.forename: Luiz Jacintho
authors.initials: LJ
authors.lastname: da Silva
authors.forename: Elvira Maria
authors.initials: EM
authors.lastname: Mendes do Nascimento
authors.forename: Fabiana Cristina
authors.initials: FC
authors.lastname: Pereira dos Santos
authors.forename: David Everson
authors.initials: DE
authors.lastname: Uip
mesh_terms: D000328:Adult; D000907:Antibodies, Bacterial / Q000097:blood; D001021:Aortic Valve / Q000382:microbiology / Q000473:pathology; D001473:Bartonella; D001474:Bartonella Infections / Q000175:diagnosis*; D016997:Coxiella burnetii; D003937:Diagnosis, Differential; D004697:Endocarditis, Bacterial / Q000382:microbiology*; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D008297:Male; D008875:Middle Aged; D011778:Q Fever / Q000175:diagnosis*; D012189:Retrospective Studies
chemical_list: D000907:Antibodies, Bacterial; D007074:Immunoglobulin G