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Volume 23, Number 8—August 2017
CME ACTIVITY - Synopsis

Bartonella quintana, an Unrecognized Cause of Infective Endocarditis in Children in Ethiopia

Diana TasherComments to Author , Alona Raucher-Sternfeld, Akiva Tamir, Michael Giladi, and Eli Somekh
Author affiliations: Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel (D. Tasher, A. Raucher-Sternfeld, A. Tamir, M. Giladi, E. Somekh); Wolfson Medical Center, Holon, Israel (D. Tasher, A. Raucher-Sternfeld, A. Tamir, E. Somekh); Tel Aviv Sourasky Medical Center, Tel Aviv (M. Giladi); European Paediatric Association–Union of National European Paediatric Societies and Associations, Berlin, Germany (E. Somekh)

Main Article

Table

Features for children from Ethiopia with Bartonella quintana endocarditis*

Patient, age, y/sex
 Echo finding
 Underlying condition
 Phenomena
 Microbiologic evidence
 CRP, mg/dL
 ESR, mm/h
 Leuk/mm3
 Hb, g/dL
 Platelets/ mm3†
Vascular
 Immunologic
A, 7/F
 Several vegetations (11 mm) on pulmonary valve
 CHD
 No
 RF Ab, 189 IU/mL
 Bartonella IgG titer 1:1,600, IgM neg; excised vegetation PCR-neg for Coxiella burnetii, PCR-pos for B. quintana‡
 1.7
 128
 3,500
 8.5
 150,000
B, 12/F
 Vegetation (7 mm) on mitral valve
 RHD
 No
 RF Ab, <10 IU/mL
 Bartonella IgG titer 1:100, IgM neg; excised vegetation PCR-neg for C. burnetii, PCR-pos for B. quintana‡
 0.7
 50
 5,700
 10.3
 310,000
C, 16/F
 Two vegetations (5 mm) on aortic valve
 RHD
 Emboli to spleen
 GN; 16 Osler nodes
 Bartonella IgG titer 1:12,800 (10 wks after surgery: 1:6,400); excised vegetation PCR-neg for C. burnetii, PCR-pos for B. quintana‡
 4.2
 150
 6,900
 7.8
 334,000
D, 9/F
 Several vegetations (10 mm and 20 mm) on aortic valve
 CHD
 CVA
 RF Ab, 25 IU/mL
 Bartonella IgG titer 1:6,400 (5 wks after surgery: 1:1,600); excised vegetation PCR-neg for C. burnetii, PCR-pos for B. quintana‡
 1.5
 44
 6,100
 11.7
 189,000
E, 11/M Vegetation (14 mm) on aortic valve CHD No RF Ab, 2,560 IU/mL Bartonella IgG titer 1:6,400; C. burnetii IgM neg 2.0 110 9,100 11.8 264,000

*HIV serologic testing and blood culture results were negative for all patients, and no patients had fever. Ab, antibody; CHD, congenital heart disease CRP, C-reactive protein (reference range 0–10 mg/dL); CVA, cerebral vascular accident; Echo, echocardiogram; ESR, erythrocyte sedimentation rate (reference range 0–20 mm); GN, glomerulonephritis; Hb, hemoglobin (reference range 9.5–13.0 g/dL); Leuk, leukocytes (reference range 6,000–17,500 cells/mm3); neg, negative; pos, positive; RF, rheumatoid factor; RHD, rheumatic heart disease.
†Reference range 150–400 × 109 platelets/L.
‡Sequence comparison analysis demonstrated a 100% identity to B. quintana.

Main Article

Page created: July 11, 2017
Page updated: July 11, 2017
Page reviewed: July 11, 2017
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