title: Bartonella henselae endocarditis in Laos - 'the unsought will go undetected'.
abstract: BACKGROUND
  Both endocarditis and Bartonella infections are neglected public health problems, especially in rural Asia. Bartonella endocarditis has been described from wealthier countries in Asia, Japan, Korea, Thailand and India but there are no reports from poorer countries, such as the Lao PDR (Laos), probably because people have neglected to look.
  
  
  RESULTS
  We conducted a retrospective (2006-2012), and subsequent prospective study (2012-2013), at Mahosot Hospital, Vientiane, Laos, through liaison between the microbiology laboratory and the wards. Patients aged >1 year admitted with definite or possible endocarditis according to modified Duke criteria were included. In view of the strong suspicion of infective endocarditis, acute and convalescent sera from 30 patients with culture negative endocarditis were tested for antibodies to Brucella melitensis, Mycoplasma pneumoniae, Bartonella quintana, B. henselae, Coxiella burnetii and Legionella pneumophila. Western blot analysis using Bartonella species antigens enabled us to describe the first two Lao patients with known Bartonella henselae endocarditis.
  
  
  CONCLUSIONS
  We argue that it is likely that Bartonella endocarditis is neglected and more widespread than appreciated, as there are few laboratories in Asia able to make the diagnosis. Considering the high prevalence of rheumatic heart disease in Asia, there is remarkably little evidence on the bacterial etiology of endocarditis. Most evidence is derived from wealthy countries and investigation of the aetiology and optimal management of endocarditis in low income countries has been neglected. Interest in Bartonella as neglected pathogens is emerging, and improved methods for the rapid diagnosis of Bartonella endocarditis are needed, as it is likely that proven Bartonella endocarditis can be treated with simpler and less expensive regimens than "conventional" endocarditis and multicenter trials to optimize treatment are required. More understanding is needed on the risk factors for Bartonella endocarditis and the importance of vectors and vector control.
authors.affiliation: Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic.
authors.forename: Sayaphet
authors.initials: S
authors.lastname: Rattanavong
authors.affiliation: URMITE, IHU Mediterranee-Infection, Faculté de Médecine, Aix-Marseille Université, Marseille, France.
authors.forename: Pierre-Edouard
authors.initials: PE
authors.lastname: Fournier
authors.affiliation: Department of Cardiology, Mahosot Hospital, Vientiane, Lao People's Democratic Republic.
authors.forename: Vang
authors.initials: V
authors.lastname: Chu
authors.affiliation: Department of Cardiology, Mahosot Hospital, Vientiane, Lao People's Democratic Republic.
authors.forename: Khamthavy
authors.initials: K
authors.lastname: Frichitthavong
authors.affiliation: Department of Cardiology, Mahosot Hospital, Vientiane, Lao People's Democratic Republic.
authors.forename: Pany
authors.initials: P
authors.lastname: Kesone
authors.affiliation: Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic; Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao People's Democratic Republic; Centre for Tropical Medicine and Global Health, Churchill Hospital, University of Oxford, United Kingdom.
authors.forename: Mayfong
authors.initials: M
authors.lastname: Mayxay
authors.affiliation: INSERM U970, Paris Cardiovascular Research Center - PARCC, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: Mariana
authors.initials: M
authors.lastname: Mirabel
authors.affiliation: Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic; Centre for Tropical Medicine and Global Health, Churchill Hospital, University of Oxford, United Kingdom.
authors.forename: Paul N
authors.initials: PN
authors.lastname: Newton
mesh_terms: D000368:Aged; D016917:Angiomatosis, Bacillary / Q000150:complications*; D004697:Endocarditis, Bacterial / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D007812:Laos; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors