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      Bartonella clarridgeiae infection in a patient with aortic root abscess and endocarditis

      case-report

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          Abstract

          Introduction.

          Bartonella species are increasingly recognized as agents of culture-negative endocarditis. However, to date, almost all human cases have been associated with two members of the genus, Bartonella henselae and Bartonella quintana. B. henselae infections are zoonotic, with domestic cats serving as reservoir hosts for the pathogen. Bartonella clarridgeiae also exploits cats as reservoir hosts, but its zoonotic potential is far less established.

          Case presentation.

          A 34-year-old male presented with palpitations after a history of aortic incompetence. During surgery for an aortic valve replacement, two vegetations were found on the aortic valve. PCR analysis of the vegetation demonstrated the presence of Bartonella species and so the patient was treated post-operatively with ceftriaxone and doxycycline, making a good recovery. Further PCR-based analysis of the patient’s aortic vegetation confirmed the presence of B. clarridgeiae .

          Conclusion.

          This report expands the number of Bartonella species associated with endocarditis and provides clear evidence that B. clarridgeiae should be considered a zoonotic pathogen.

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          Most cited references14

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          Serological cross-reactions between Bartonella quintana, Bartonella henselae, and Coxiella burnetii.

          The clinical manifestations of Q fever and bartonelloses can be confused, especially in cases of infectious endocarditis. Differential diagnosis of the diseases is important because the treatments required for Q fever and bartonelloses are different. Laboratory confirmation of a suspected case of either Q fever or bartonelloses is most commonly made by antibody estimation with an indirect immunofluorescence assay. With an indirect immunofluorescence assay, 258 serum samples from patients with Q fever were tested against Bartonella henselae and Bartonella quintana antigens, and 77 serum samples from patients with infection by Bartonella sp. were tested against Coxiella burnetii antigen. Cross-reactivity was observed: more than 50% of the chronic Q fever patients tested had antibodies which reacted against B. henselae antigen to a significant level. This cross-reaction was confirmed by a cross-adsorption study and protein immunoblotting. However, because the levels of specific antibody titers in cases of Bartonella endocarditis are typically extremely high, low-level cross-reaction between C. burnetii antibodies and B. henselae antigen in cases of Q fever endocarditis should not lead to misdiagnosis, provided serology testing for both agents is performed.
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            Bartonella, a common cause of endocarditis: a report on 106 cases and review.

            Bartonella spp. are fastidious bacteria that cause blood culture-negative endocarditis and have been increasingly reported. In this study, we included all patients retrospectively and prospectively diagnosed with Bartonella endocarditis in our French reference center between 2005 and 2013. Our diagnosis was based on the modified Duke criteria and microbiological findings, including serological and PCR results. To review the published literature, we searched all human Bartonella endocarditis cases published in the PubMed database between January 2005 and October 2013. We report here a large series of 106 cases, which include 59 cases that had not previously been reported or mentioned. Indirect immunofluorescence assays, Western blotting, and real-time PCR from total blood, serum, and valve tissue exhibited sensitivities of 58%, 100%, 33%, 36%, and 91%, respectively. The number of cases reported in the literature between 2005 and 2013 increased to reach a cumulative number of 196 cases. The number of cases reported in the literature by other centers is increasing more rapidly than that reported by our French reference center (P < 10(-2)). Currently, there is a lack of criteria for the diagnosis of Bartonella endocarditis. We suggest that a positive PCR result from a cardiac valve or blood specimen, an IgG titer of ≥800 using an immunofluorescence assay, or a positive Western blot assay be considered major Duke criteria for Bartonella endocarditis. There is no real increase in the incidence of these infections but rather a better understanding and interest in the disease resulting from the improvement of diagnostic tools.
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              Comparison of partial citrate synthase gene (gltA) sequences for phylogenetic analysis of Bartonella species.

              Nucleotide base sequence data were obtained for a 940-bp fragment of the citrate synthase-encoding gene (gltA) of representatives of the eight validly described Bartonella species and seven uncharacterized Bartonella strains obtained from small mammals. Complete 16S rRNA gene sequences were also determined for the uncharacterized strains, and these sequences revealed that each strain had a unique sequence which was very similar to the sequences of the previously recognized Bartonella species. A comparison of the gltA sequences of the different Bartonella species revealed that the levels of similarity between sequences were 83.8 to 93.5%, whereas comparisons of sequences obtained from different strains of the same species revealed that the levels of similarity were more than 99.8%. One of the uncharacterized strains had a gltA sequence that matched the sequence of Bartonella elizabethae, three uncharacterized strains had sequences which were more than 99.6% similar to each other (but less than 93.5% similar to any other sequence), and the remaining three uncharacterized strains each exhibited less than 93.5% sequence similarity to other Bartonella species or isolates. Phylogenetic trees were inferred from multiple alignments of both gltA and 16S ribosomal DNA (rDNA) sequences. Whereas the proposed intra-Bartonella architecture of trees inferred from 16S rDNA sequence data by using both distance matrix and parsimony methods had virtually no statistical support, the trees inferred from the gltA sequence data contained four well-supported lineages in the genus. The gltA-derived phylogeny appears to be more useful than the phylogeny derived from 16S rDNA sequence data for investigating the evolutionary relationships of Bartonella species, and the validity of the lineages identified by the gltA analysis is discussed in this paper.
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                Author and article information

                Journal
                Access Microbiol
                Access Microbiol
                acmi
                acmi
                Access Microbiology
                Microbiology Society
                2516-8290
                2019
                10 October 2019
                10 October 2019
                : 1
                : 10
                : e000064
                Affiliations
                [ 1] departmentBacterial Reference Department , Public Health England , London NW9 5EQ, UK
                [ 2] departmentSchool of Science, Engineering and Environment , University of Salford , Manchester M5 4WT, UK
                [ 3] departmentMicrobiology Department , St James’s Hospital , Dublin 8, Ireland
                Author notes
                *Correspondence: Richard J. Birtles, r.j.birtles@ 123456salford.ac.uk
                Author information
                https://orcid.org/0000-0001-6826-7420
                https://orcid.org/0000-0001-8040-765X
                https://orcid.org/0000-0001-6401-6421
                https://orcid.org/0000-0002-4216-5044
                Article
                000064
                10.1099/acmi.0.000064
                7491929
                32974498
                7b759326-070a-4be6-9518-fc836e3d2194
                © 2019 The Authors

                This is an open-access article distributed under the terms of the Creative Commons Attribution License.

                History
                : 09 August 2019
                : 18 September 2019
                Categories
                Case Report
                Custom metadata
                0

                endocarditis,zoonosis,bartonella
                endocarditis, zoonosis, bartonella

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