Raoult D, Fournier P E, Drancourt M, Marrie T J, Etienne J, Cosserat J, Cacoub P, Poinsignon Y, Leclercq P, Sefton A M
Unité des Rickettsies, CNRS EPJ0054, Faculté de Médecine, Marseille, France.
Ann Intern Med. 1996 Oct 15;125(8):646-52. doi: 10.7326/0003-4819-125-8-199610150-00004.
Bartonella species are emerging pathogens that are seldom reported as a cause of blood culture-negative endocarditis.
To report the occurrence of, risk factors for, and clinical features of Bartonella endocarditis and to evaluate the diagnostic tools available for this condition.
Case series and comparison with past series.
Multicenter international study in Halifax, Nova Scotia, Canada; Lyon, France; and Marseille, France.
22 patients from France, England, Canada, and South Africa were investigated for blood culture-negative endocarditis.
Titer of antibodies to Bartonella species by microimmunofluorescence assay, blood or vegetation culture, and amplification of Bartonella DNA from valvular tissue by polymerase chain reaction. Cross-adsorption was done for patients with antibodies to Chlamydia species.
22 patients had definite endocarditis. Five were infected with B. quintana, 4 with B. henselae, and 13 with an undetermined Bartonella species. These cases were compared with the 11 previously reported cases. Of the patients with the newly reported cases, 19 had valvular surgery and 6 died. Nine were homeless, 11 were alcoholic, 4 owned cats, and 13 had preexisting valvular heart disease. Bartonella species caused 3% of the cases of endocarditis seen in the three study centers. The patients with these cases could have previously received a diagnosis of chlamydial endocarditis because of apparently high levels of cross-reacting antibodies to Chlamydia species.
Bartonella species are an important cause of blood culture-negative endocarditis and can be identified by culture, serologic studies, or molecular biology techniques. Alcoholism and homelessness without previous valvular heart disease are risk factors for B. quintana infection but not for infection with other Bartonella species.
巴尔通体属是新出现的病原体，很少被报道为血培养阴性的心内膜炎病因。
报告巴尔通体心内膜炎的发生情况、危险因素和临床特征，并评估针对这种疾病的可用诊断工具。
病例系列研究并与既往系列进行比较。
加拿大新斯科舍省哈利法克斯、法国里昂和法国马赛的多中心国际研究。
对来自法国、英国、加拿大和南非的22例血培养阴性的心内膜炎患者进行调查。
通过微量免疫荧光测定法检测抗巴尔通体属抗体滴度、进行血培养或赘生物培养，以及通过聚合酶链反应从瓣膜组织中扩增巴尔通体DNA。对衣原体属抗体阳性的患者进行交叉吸附试验。
22例患者确诊为心内膜炎。5例感染五日热巴尔通体，4例感染亨氏巴尔通体，13例感染未确定的巴尔通体属物种。将这些病例与之前报告的11例病例进行比较。新报告病例的患者中，19例行瓣膜手术，6例死亡。9例无家可归，11例酗酒，4例养猫，13例有既往瓣膜性心脏病。在三个研究中心，巴尔通体属导致了3%的心内膜炎病例。这些病例的患者之前可能因对衣原体属有明显高水平的交叉反应抗体而被诊断为衣原体心内膜炎。
巴尔通体属是血培养阴性的心内膜炎的重要病因，可通过培养、血清学研究或分子生物学技术进行鉴定。酗酒和无既往瓣膜性心脏病的无家可归状态是五日热巴尔通体感染的危险因素，但不是其他巴尔通体属物种感染的危险因素。
