We present a case of culture-negative endocarditis
and acute kidney injury due to glomerulonephritis, due to Bartonella henselae cardiac valve infection.
The Duke criteria maybe inadequate for blood culture-negative endocarditis
due mainly to preceding antibiotic administration or to fastidious slow-growing organisms [6, 7].
This case serves to illustrate the potential value of PCR and DNA sequencing in diagnosing culture-negative endocarditis
and the potential role of Dietzia spp.
Serological tests often give an indication of the likely pathogen in culture-negative endocarditis
. Our case was complicated by positive acute serology for both Legionella spp.
We have previously reported on the impact of prior antibiotic use in culture-negative endocarditis
. (18) Prior antibiotic therapy before clinical presentation (seen in 52% of our study group) was the primary contributor to the high incidence (54%) of negative blood cultures in our series.
In 1998, the patient had undergone aortic valve replacement for culture-negative endocarditis
and valvular insufficiency.
Demographic and clinical features of patients with blood culture-negative endocarditis
included in the study.
We obtained blood samples for cultures and then initiated empirical therapy with doxycycline and ceftriaxone for presumed common and culture-negative endocarditis
For the 51 culture-negative endocarditis
patients, Bartonella spp.
Blood culture-negative endocarditis
accounts for 2.5%-31.0% of all cases of endocarditis.
This case reinforces the hypothesis that any Bartonella species can cause human infection, including culture-negative endocarditis
. Candidatus B.
Cases of culture-negative endocarditis
are not routinely investigated for mycoplasmas; however, the role of these microorganisms as a cause of endocarditis might be underestimated.