Patel Sonika, Richert Mary Elizabeth, White Rachel, Lambing Tyler, Saleeb Paul
Department of Internal Medicine, University of Maryland Medical Center, Baltimore, MD, USA.
Department of Pathology, University of Maryland Medical Center, Baltimore, MD, USA.
Am J Case Rep. 2019 Apr 26;20:602-606. doi: 10.12659/AJCR.915215.
BACKGROUND Culture-negative Bartonella quintana endocarditis is challenging to diagnose and is associated with high mortality rates. Diagnostic confirmation of Bartonella quintana infection requires specialized assays, as identifying Bartonella henselae endocarditis by serology can be difficult due to the high rate of serological cross-reactivity. This is a case report of culture-negative Bartonella quintana endocarditis that was diagnosed with epidemiologic data, histology, and nucleic acid amplification testing. CASE REPORT A 28-year-old man with a history of homelessness was admitted to hospital with worsening productive cough, weight loss, and abdominal pain. A transthoracic echocardiogram (TTE) showed pulmonary valve vegetation and several aortic valve vegetations. His hospital course was complicated by cardiogenic shock and septic shock requiring transfer to a tertiary care medical intensive care unit. Although blood cultures remained negative for bacterial infection, serology testing was positive for Bartonella henselae and Bartonella quintana IgM and IgG. Nucleic acid amplification testing for 16S ribosomal RNA (rRNA) using valve tissue was diagnostic for Bartonella quintana. CONCLUSIONS This case of culture-negative Bartonella quintana endocarditis demonstrates the use of diagnostic nucleic acid amplification methods to confirm the diagnosis.
背景 培养阴性的五日热巴尔通体心内膜炎诊断具有挑战性，且死亡率高。五日热巴尔通体感染的诊断确认需要专门的检测方法，因为由于血清学交叉反应率高，通过血清学鉴定亨氏巴尔通体心内膜炎可能很困难。这是一例通过流行病学数据、组织学和核酸扩增检测诊断为培养阴性的五日热巴尔通体心内膜炎的病例报告。病例报告 一名有流浪史的28岁男性因咳嗽加重、体重减轻和腹痛入院。经胸超声心动图（TTE）显示肺动脉瓣赘生物和多个主动脉瓣赘生物。他的住院过程因心源性休克和感染性休克而复杂化，需要转至三级医疗重症监护病房。尽管血培养细菌感染结果仍为阴性，但血清学检测显示亨氏巴尔通体和五日热巴尔通体IgM和IgG呈阳性。使用瓣膜组织进行的16S核糖体RNA（rRNA）核酸扩增检测确诊为五日热巴尔通体。结论 该例培养阴性的五日热巴尔通体心内膜炎病例展示了使用诊断性核酸扩增方法来确诊。
