Kitamura Mineaki, Dasgupta Alana, Henricks Jonathan, Parikh Samir V, Nadasdy Tibor, Clark Edward, Bazan Jose A, Satoskar Anjali A
Department of Pathology, Division of Renal and Transplant Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, United States.
Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Front Nephrol. 2024 Jan 15;3:1322741. doi: 10.3389/fneph.2023.1322741. eCollection 2023.
Although is the leading cause of acute infective endocarditis (IE) in adults, spp. has concomitantly emerged as the leading cause of "blood culture-negative IE" (BCNE). Pre-disposing factors, clinical presentation and kidney biopsy findings in Bartonella IE-associated glomerulonephritis (GN) show subtle differences and some unique features relative to other bacterial infection-related GNs. We highlight these features along with key diagnostic clues and management approach in Bartonella IE-associated GN.
We conducted a pooled analysis of 89 cases of Bartonella IE-associated GN (54 published case reports and case series; 18 published conference abstracts identified using an English literature search of several commonly used literature search modalities); and four unpublished cases from our institution.
and are the most commonly implicated species causing IE in humans. Subacute presentation, affecting damaged native and/or prosthetic heart valves, high titer anti-neutrophil cytoplasmic antibodies (ANCA), mainly proteinase-3 (PR-3) specificity, fastidious nature and lack of positive blood cultures of these Gram-negative bacilli, a higher frequency of focal glomerular crescents compared to other bacterial infection-related GNs are some of the salient features of Bartonella IE-associated GN. C3-dominant, but frequent C1q and IgM immunofluorescence staining is seen on biopsy. A "full-house" immunofluorescence staining pattern is also described but can be seen in IE -associated GN due to other bacteria as well. Non-specific generalized symptoms, cytopenia, heart failure and other organ damage due to embolic phenomena are the highlights on clinical presentation needing a multi-disciplinary approach for management. Awareness of the updated modified Duke criteria for IE, a high index of suspicion for underlying infection despite negative microbiologic cultures, history of exposure to animals, particularly infected cats, and use of send-out serologic tests for spp. early in the course of management can help in early diagnosis and initiation of appropriate treatment.
Diagnosis of IE-associated GN can be challenging particularly with BCNE. The number of Bartonella IE-associated GN cases in a single institution tends to be less than IE due to gram positive cocci, however Bartonella is currently the leading cause of BCNE. We provide a much-needed discussion on this topic.
尽管[具体细菌名称1]是成人急性感染性心内膜炎（IE）的主要病因，但[具体细菌名称2]属已同时成为“血培养阴性IE”（BCNE）的主要病因。巴尔通体IE相关肾小球肾炎（GN）的易感因素、临床表现及肾活检结果与其他细菌感染相关的GN相比，存在细微差异和一些独特特征。我们重点介绍这些特征以及巴尔通体IE相关GN的关键诊断线索和管理方法。
我们对89例巴尔通体IE相关GN病例进行了汇总分析（54篇已发表的病例报告和病例系列；通过对几种常用文献检索方式进行英文文献检索确定的18篇已发表会议摘要）；以及我们机构的4例未发表病例。
[具体细菌名称1]和[具体细菌名称2]是人类IE最常见的相关菌种。亚急性表现、累及受损的天然和/或人工心脏瓣膜、高滴度抗中性粒细胞胞浆抗体（ANCA），主要是蛋白酶3（PR - 3）特异性、这些革兰氏阴性杆菌的苛求特性以及血培养阴性、与其他细菌感染相关的GN相比局灶性肾小球新月体发生率更高，是巴尔通体IE相关GN的一些显著特征。活检可见以C3为主，但C1q和IgM免疫荧光染色频繁。也描述了一种“满堂亮”免疫荧光染色模式，但在其他细菌引起的IE相关GN中也可见到。非特异性全身症状、血细胞减少、心力衰竭以及栓塞现象导致的其他器官损害是临床表现的重点，需要多学科方法进行管理。了解IE更新后的改良杜克标准、尽管微生物培养阴性但对潜在感染的高度怀疑指数、动物接触史，特别是感染猫的接触史，以及在管理过程早期使用针对[具体细菌名称2]属的外送血清学检测，有助于早期诊断和启动适当治疗。
IE相关GN的诊断可能具有挑战性，尤其是BCNE。由于革兰氏阳性球菌导致的IE，单个机构中巴尔通体IE相关GN病例数往往少于IE，但巴尔通体目前是BCNE的主要病因。我们提供了关于该主题急需的讨论。
