Delama Ignacio, Mondaca Roberto, Aguayo Ignacia, Roldán Andrés, Ferrés Marcela, Fica Alberto
Subdepartamento de Medicina, Hospital Base de Valdivia, Valdivia, Chile.
Escuela de Graduados, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile.
Rev Med Chil. 2019 Oct;147(10):1340-1345. doi: 10.4067/s0034-98872019001001340.
Infectious endocarditis (IE) by Bartonella species is an emerging problem worldwide. We report two cases of native valve Bartonella-associated IE events, both affecting adult male patients with a history of alcohol abuse and a low socioeconomic status. Admissions were due to pancytopenia and bleeding in one case and embolic stroke in the other. Blood cultures were negative and IgG indirect immunofluorescence assays (IFA) were positive for B. henselae/B. quintana in high titers (1/16,384-1/16,384, and 1/32,768 -1/16,384, respectively). Cases were classified as definitive IE events according to modified Duke criteria due to the presence of valve vegetations with at least three minor criteria. One patient required aortic mechanical valve replacement and survived, and the other died after a massive hemorrhagic transformation of his stroke. PCR amplification and sequencing of the 16S ribosomal bacterial DNA from a valve tissue sample obtained at surgery in the patient who survived, confirmed B. quintana as the etiological agent. Bartonella-associated IE is an emerging problem in Chile, present in disadvantaged populations. It should be suspected in patients with culture-negative IE. IFA does not discriminate between B. henselae and B. quintana infection, but high titers suggest IE. Complementary PCR techniques may help to elucidate the final causative agent.
巴尔通体属引起的感染性心内膜炎（IE）在全球范围内是一个新出现的问题。我们报告两例原发性瓣膜巴尔通体相关性IE事件，均累及成年男性患者，他们有酗酒史且社会经济地位较低。一例因全血细胞减少和出血入院，另一例因栓塞性中风入院。血培养均为阴性，而IgG间接免疫荧光试验（IFA）检测显示，两例患者针对汉赛巴尔通体/五日热巴尔通体均呈高滴度阳性（分别为1/16,384 - 1/16,384和1/32,768 - 1/16,384）。根据改良的杜克标准，由于存在瓣膜赘生物且至少有三条次要标准，这两例均被归类为确诊的IE事件。一名患者接受了主动脉机械瓣膜置换并存活下来，另一名患者在中风后发生大面积出血性转化，最终死亡。对存活患者手术时获取的瓣膜组织样本进行16S核糖体细菌DNA的PCR扩增和测序，证实五日热巴尔通体为病原体。巴尔通体相关性IE在智利是一个新出现的问题，在弱势群体中存在。对于血培养阴性的IE患者应怀疑此病。IFA无法区分汉赛巴尔通体和五日热巴尔通体感染，但高滴度提示IE。补充性PCR技术可能有助于明确最终病原体。
