Hoffman Risa M, AboulHosn Jamil, Child John S, Pegues David A
Division of Infectious Diseases, Department of Internal Medicine, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.
Congenit Heart Dis. 2007 Jan-Feb;2(1):79-84. doi: 10.1111/j.1747-0803.2007.00077.x.
Bartonella species are an important cause of culture-negative endocarditis, with recognized risk factors of alcoholism, homelessness, cat exposure, and pre-existing valvular disease. We report a case of Bartonella henselae endocarditis in a 36-year-old woman with complex congenital heart disease who presented with a 7-month history of hemolytic anemia, leukocytoclastic vasculitis, and recurrent fevers. Transesophageal echocardiogram revealed vegetations on the patient's native aortic valve and in the right ventricular to pulmonary artery conduit and associated bioprosthetic valve. Diagnosis of B. henselae was confirmed with serum antibody and polymerase chain reaction (PCR) testing and tissue stains. The patient was treated successfully with surgical resection and prolonged antimicrobial therapy with ceftriaxone, gentamicin, and doxycycline. A review of the literature suggests prosthetic valves and complex congenital heart disease are risk factors for Bartonella endocarditis, and a high index of suspicion with antibody and PCR testing can expedite diagnosis and improve outcomes.
巴尔通体属细菌是血培养阴性的心内膜炎的重要病因,已知的危险因素包括酗酒、无家可归、接触猫以及原有瓣膜疾病。我们报告一例36岁患有复杂先天性心脏病的女性感染汉赛巴尔通体心内膜炎的病例,该患者有7个月的溶血性贫血、白细胞破碎性血管炎和反复发热病史。经食管超声心动图显示患者的主动脉瓣、右心室至肺动脉管道及相关生物瓣膜上有赘生物。通过血清抗体、聚合酶链反应(PCR)检测及组织染色确诊为汉赛巴尔通体感染。患者经手术切除并使用头孢曲松、庆大霉素和多西环素进行长期抗菌治疗后成功治愈。文献综述表明,人工瓣膜和复杂先天性心脏病是巴尔通体心内膜炎的危险因素,高度怀疑时进行抗体和PCR检测可加快诊断并改善预后。