title: Melody Valve Bartonella henselae Endocarditis in an Afebrile Teen: A Case Report.
abstract: Significant advancements in the care of children with cardiac valve disease over the past 15 years have led to the increasingly common use of percutaneous transcatheter valve implantation as an alternative to surgical replacement in selected patient populations. Although the transcatheter approach has several advantages, this approach and the valves used are not without complications. Bacterial endocarditis is a known and concerning complication after transcatheter pulmonary valve replacement (TPVR). Most reported cases have involved organisms that are common etiologic agents of bacterial endocarditis and are readily identified via blood culture. However, culture-negative endocarditis in the setting of TPVR has not been well described. We present our experience with one afebrile teenager with culture-negative, serology-positive Bartonella henselae endocarditis of a Melody valve 18 months after TPVR for management of tetralogy of Fallot. The teen was successfully managed with long-term antibiotic therapy followed by surgical replacement of the valve. To our knowledge, this is the first reported case of culture-negative endocarditis of a Melody TPVR in the absence of fever. This report discusses the importance of considering culture-negative endocarditis in the differential diagnosis of an afebrile patient with TPVR presenting with constitutional symptoms and valve dysfunction, particularly in the primary care setting. It is anticipated that with an increase in the successfully aging population of children who have undergone cardiac repair, the evaluation of these patients will become an increasingly important and common task for the community pediatrician.
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Tina
authors.initials: T
authors.lastname: Sosa
authors.affiliation: Department of Pediatric Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Bryan
authors.initials: B
authors.lastname: Goldstein
authors.affiliation: Department of Pediatric Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: James
authors.initials: J
authors.lastname: Cnota
authors.affiliation: Department of Pediatric Cardiac Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Roosevelt
authors.initials: R
authors.lastname: Bryant
authors.affiliation: Department of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Robert
authors.initials: R
authors.lastname: Frenck
authors.affiliation: Department of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Matthew
authors.initials: M
authors.lastname: Washam
authors.affiliation: Department of Pediatric Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio nicolas.madsen@cchmc.org.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Madsen
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D018416:Bartonella henselae; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D004697:Endocarditis, Bacterial / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D006349:Heart Valve Diseases / Q000382:microbiology*; D006801:Humans; D008297:Male
chemical_list: D000900:Anti-Bacterial Agents