西南印度洋 12 例巴尔通体 quintana 心内膜炎的病例系列。
Case series of 12 Bartonella quintana endocarditis from the Southwest Indian Ocean.
机构信息
Laboratoire de Bactériologie, CHU Félix Guyon, Saint-Denis, La Réunion, France.
UMR Processus Infectieux en Milieu Insulaire Tropical (PIMIT), CNRS 9192, INSERM U1187, IRD 249, Université de La Réunion, Saint-Denis, La Réunion, France.
出版信息
PLoS Negl Trop Dis. 2023 Sep 7;17(9):e0011606. doi: 10.1371/journal.pntd.0011606. eCollection 2023 Sep.
BACKGROUND
Bartonella spp. are fastidious bacteria frequently identified as the cause of blood culture-negative (BCN) endocarditis. However, Bartonella infections are difficult to diagnose in routine laboratory testing and their incidence is probably underestimated. We investigated the epidemiological and clinical features of Bartonella endocarditis cases diagnosed between 2009 and 2021 on Reunion Island (Southwest Indian Ocean).
METHOD
We retrospectively included all patients diagnosed with Bartonella endocarditis at Reunion Island University Hospital during this period. Endocarditis was diagnosed on the basis of microbiological findings, including serological tests (IFA) and PCR on cardiac valves, and the modified Duke criteria. We used then the multispacer typing (MST) method to genotype the available Bartonella strains.
FINDINGS
We report 12 cases of B. quintana endocarditis on Reunion Island (83.3% in men, median patient age: 32 years). All the patients originated from the Comoros archipelago. The traditional risk factors for B. quintana infection (homelessness, alcoholism, exposure to body lice) were absent in all but two of the patients, who reported head louse infestations in childhood. Previous heart disease leading to valve dysfunction was recorded in 50% of patients. All patients underwent cardiac valve surgery and antimicrobial therapy with a regimen including doxycycline. All patients presented high C-reactive protein concentrations, anemia and negative blood cultures. The titer of IgG antibodies against Bartonella sp. exceeded 1:800 in 42% of patients. Specific PCR on cardiac valves confirmed the diagnosis of B. quintana endocarditis in all patients. Genotyping by the MST method was performed on four strains detected in preserved excised valves and was contributive for three, which displayed the MST6 genotype.
CONCLUSIONS
Bartonella quintana is an important cause of infective endocarditis in the Comoros archipelago and should be suspected in patients with mitral valve dysfunction and BCN from this area.
背景
巴尔通体属细菌是一种苛刻的细菌，常被确定为血培养阴性（BCN）心内膜炎的病因。然而，巴尔通体感染在常规实验室检测中难以诊断，其发病率可能被低估。我们研究了 2009 年至 2021 年期间在留尼汪岛（西南印度洋）诊断的巴尔通体心内膜炎病例的流行病学和临床特征。
方法
我们回顾性纳入了在此期间在留尼汪岛大学医院诊断为巴尔通体心内膜炎的所有患者。心内膜炎的诊断基于微生物学发现，包括心脏瓣膜的血清学检测（IFA）和 PCR，以及改良的杜克标准。然后，我们使用多间隔分型（MST）方法对可获得的巴尔通体菌株进行基因分型。
结果
我们报告了留尼汪岛 12 例 B. quintana 心内膜炎病例（83.3%为男性，中位患者年龄：32 岁）。所有患者均来自科摩罗群岛。除了两名患者报告在儿童时期头部有虱子感染外，传统的 B. quintana 感染危险因素（无家可归、酗酒、接触体虱）在所有患者中均不存在。50%的患者有导致瓣膜功能障碍的先前心脏病。所有患者均接受了心脏瓣膜手术和包括多西环素在内的抗菌治疗。所有患者均表现出高 C 反应蛋白浓度、贫血和阴性血培养。42%的患者针对 Bartonella sp. 的 IgG 抗体滴度超过 1:800。心脏瓣膜的特异性 PCR 证实了所有患者的 B. quintana 心内膜炎诊断。对保存在切除瓣膜中检测到的 4 株菌株进行 MST 方法基因分型，对其中 3 株有贡献，显示 MST6 基因型。
结论
B. quintana 是科摩罗群岛感染性心内膜炎的重要病因，应怀疑来自该地区的二尖瓣功能障碍和 BCN 患者患有此病。
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