title: Case series ofBartonella quintanablood culture-negative endocarditis in Washington, DC.
abstract: BACKGROUND
  Prior studies (predominantly from Europe) have demonstrated blood culture-negative endocarditis due toBartonella. Our objective was to describe three cases ofBartonella quintanaendocarditis identified within one year at a large hospital in Washington, DC, USA.
  
  
  METHODS
  We constructed a descriptive case series from a retrospective review of medical records from April to December 2013 at an 800-bed urban hospital. All three patients (ages: 52, 55 and 57 years) were undomiciled/homeless men with a history of alcoholism. Although they had negative blood cultures, echocardiography demonstrated aortic/mitral valve perforation and regurgitation in one patient, aortic/mitral valve vegetation with mitral regurgitation in the second patient, and aortic valve vegetation with regurgitation in the third patient. The patients had positiveBartonella quintanaserum immunoglobulin G (IgG) with negative immunoglobulin M (IgM). PCR on DNA extracted from cardiac valves was positive forBartonella, and DNA sequencing of PCR amplicons identifiedBartonella quintana. Patients received treatment with doxycycline/rifampin or doxycycline/gentamicin.
  
  
  CONCLUSIONS
  Clinicians should considerBartonellaendocarditis as a differential diagnosis in patients who fit elements of the Duke Criteria, as well as having a history of homelessness and alcoholism.
authors.affiliation: Infectious Disease Section, MedStar Washington Hospital Center , Washington , USA.
authors.forename: Fisseha Y
authors.initials: FY
authors.lastname: Ghidey
authors.affiliation: Infectious Disease Section, MedStar Washington Hospital Center , Washington , USA.
authors.forename: Osamuyimen
authors.initials: O
authors.lastname: Igbinosa
authors.affiliation: Infectious Disease Section, MedStar Washington Hospital Center , Washington , USA.
authors.forename: Kristin
authors.initials: K
authors.lastname: Mills
authors.affiliation: Infectious Disease Section, MedStar Washington Hospital Center , Washington , USA.
authors.forename: Leon
authors.initials: L
authors.lastname: Lai
authors.affiliation: Infectious Disease Section, MedStar Washington Hospital Center , Washington , USA.
authors.forename: Christian
authors.initials: C
authors.lastname: Woods
authors.affiliation: Infectious Disease Section, MedStar Washington Hospital Center , Washington , USA.
authors.forename: Maria E
authors.initials: ME
authors.lastname: Ruiz
authors.affiliation: Infectious Disease Section, MedStar Washington Hospital Center , Washington , USA.
authors.forename: Dawn
authors.initials: D
authors.lastname: Fishbein
authors.affiliation: Mayo Clinical Laboratory , Rochester, MN , USA.
authors.forename: Rahul
authors.initials: R
authors.lastname: Sampath
authors.affiliation: Infectious Disease Section, MedStar Washington Hospital Center , Washington , USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Lowery
authors.affiliation: Infectious Disease Section, MedStar Washington Hospital Center , Washington , USA.
authors.forename: Glenn
authors.initials: G
authors.lastname: Wortmann
keywords:  endocarditis; Bartonella quintana; Culture-negative 