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Volume 30, Number 12—December 2024
Synopsis

Bartonella quintana Endocarditis in Persons Experiencing Homelessness, New York, New York, USA, 2020–2023

Marina Keller1, Mariam Agladze, Tania Kupferman, Shannan N. Rich, Grace E. Marx, Rachel Gnanaprakasam, Rich Kodama, Marta Feldmesser, Kara Mitchell, Danielle Wroblewski, Stefan Juretschko, George M. Kleinman, Matthew J. Kuehnert, Julu Bhatnagar, Marlene Deleon Carnes, Hannah Bullock, Sarah Reagan-Steiner, Gabriella Corvese, and Joel Ackelsberg1Comments to Author 
Author affiliation: Westchester Medical Center, Valhalla, New York, USA (M. Keller, R. Gnanaprakasam, G.M. Kleinman); New York University Grossman School of Medicine, New York, New York, USA (T. Kupferman, M. Agladze); Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (S.N. Rich, G.E. Marx); Memorial Sloan Kettering Cancer Center, New York (R. Kodama); Lenox Hill Hospital, New York (M. Feldmesser); New York State Department of Health, Albany, New York, USA (K. Mitchell, D. Wroblewski); Northwell Health Laboratories, Little Neck, New York, USA (S. Juretschko); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (M.J. Kuehnert, J. Bhatnagar, M.D. Carnes, H. Bullock, S. Reagan-Steiner); New York City Department of Homeless Services, New York (G. Corvese); New York City Department of Health and Mental Hygiene, Long Island City, New York. USA (J. Ackelsberg)

Main Article

Table

Demographic and clinical features of 5 Bartonella quintana endocarditis cases in persons experiencing homelessness, New York, New York, USA, 2020–2023*

Characteristics Case 1 Case 2 Case 3 Case 4 Case 5
Patient demographics
Age, y ≈50 ≈50 ≈70 ≈50 ≈60
Sex M M F M M
Race/ethnicity
 Black
 Middle Eastern
 Unknown
 Hispanic
 Asian
Admission values
Temperature at admission, °C 37.0 36.2 36.7 36.4 36.9
Heart rate, beats/min 118 101 46 92 72
Respiratory rate, breaths/min 20 19 9 16 20
Blood pressure, mm Hg 138/108 123/51 82/45 111/66 138/85
Leukocytes, 103 cells/mL 8.6 11.1 17 3.1 9.5
Hemoglobin g/dL 6.2 10.3 5.8 8.6 7.8
Platelets, 103/mL 233 205 155 123 350
Creatinine, mg/dL 2.8 1.9 1.4 1.3 0.8
Albumin, g/dL 2.9 2.5 2.5 2.7 3.4
Pro-BNP, pg/mL
 Not tested
 Not tested
 2756
 40510
 Not tested
Diagnoses and course of illness
Heart failure Yes Yes Yes Yes No
Affected heart valve(s) Aortic, mitral Aortic Aortic Aortic Aortic, mitral
Valve replacement Yes Yes Yes Yes No
Renal failure Yes Yes Yes No No
Renal replacement therapy No Yes Yes No No
B. quintana IgG titer >1:1,024 1:1,280 <1:128 1:640 1:2,560
B. henselae IgG titer >1:1,024 1:2,560 >1:1,024 1:2,560 1:2,560
B. quintana IgM titer Negative Negative Negative Negative Negative
B. henselae IgM titer Negative Negative Negative Negative Negative
Molecular diagnostic assay HN-PCR valve PCR/16S rRNA valve PCR/16S rRNA valve 16S rRNA gene sequencing cfDNA, 14049 MPM
Molecular diagnosis B. quintana B. quintana B. quintana B. quintana B. quintana
Antimicrobial drugs administered before B. quintana treatment started VAN, CTX DAP, CTX VAN, P/T, CTX VAN, CTX VAN, CTX
Days before B. quintana treatment started 40 4 3 3 8
Hospitalization, d 46 79 34 33 31
Died during hospitalization No No Yes No No
Died within 1 year Yes No Yes No No
Risk factors
Alcohol use disorder Yes Yes Unknown Yes No
Illicit drug use No Yes Unknown Yes No
Schizophrenia Yes No Unknown No No
Bipolar disorder No Yes Unknown Yes No
Other mental health condition Unknown Yes Unknown Unknown No
Unsheltered homelessness at admission No Yes Presumed Yes Yes
Unsheltered homelessness within 1 year of admission Yes Yes Presumed Yes Yes
Known exposure to body lice
 Yes
 Yes
 bed bugs
 Yes
 No
*cfDNA, microbial cell-free DNA detection with next-generation sequencing; CTX, ceftriaxone; DAP, daptomycin; HN-PCR, hemi-nested PCR confirmed with sequence analysis; MPM, DNA molecules per microliter (number of DNA fragments present in 1 microliter of plasma); PCR/16S rRNA, real-time PCR of gltaA confirmed with full gene sequencing of PCR product; pro-BNP, pro-B-type natriuretic peptide; P/T, piperacillin/tazobactam.

Main Article

1These authors contributed equally to this article.

Page created: November 07, 2024
Page updated: November 26, 2024
Page reviewed: November 26, 2024
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