Diagnosis and treatment of Bartonella endocarditis

Authors: K. Kuncová 1;  H. Žemličková 1;  J. Jäger 2;  L. Ryšková 1;  L. Plíšková 3;  R. Bolehovská 3;  M. Pojar 4
Authors‘ workplace: Ústav klinické mikrobiologie Fakultní nemocnice Hradec Králové 1;  I. interní kardioangiologická klinika Fakultní nemocnice Hradec Králové 2;  Ústav klinické biochemie a diagnostiky Fakultní nemocnice Hradec Králové 3;  Kardiochirurgická klinika Fakultní nemocnice Hradec Králové 4
Published in: Epidemiol. Mikrobiol. Imunol. 68, 2019, č. 2, s. 104-108
Category: Short Communication


The Bartonella genus comprises more than 20 species of Gram-negative rods which are difficult to culture. These are facultative intracellular bacteria. Humans are reservoir hosts for B. quintana and B. bacilliformis or accidental hosts for other species. Bartonella is a cause of zoonosis. Bartonella infection can be completely asymptomatic or can be linked to various conditions. Our experience with Bartonella endocarditis from 2012–2017 is presented. The most effective diagnostic method for Bartonella endocarditis is PCR detection of DNA of the pathogen from excised valve tissue. The European Society of Cardiology (ESC) in the guidelines from 2015 recommends the combination doxycycline gentamycin for the treatment of Bartonella endocarditis.


Bartonella – endocarditis – diagnosis – treatment


1. Harms A, Dehio C. Intruders below the Radar: Molecular Pathogenesis of Bartonella spp. Clinical Microbiology Reviews, 2012;25(1):42–78.

2. Kalogeropoulos C, Koumpoulis I, Mentis A, et al. Bartonella and intraocular inflammation: a series of cases and review of literature. Clinical Ophthalmology, 2011;5:817–825.

3. Karem KL, Paddock CD, Regnery RL. Bartonella henselae, B. quintana, and B. bacilliformis: historical pathogens of emerging signifikance. Microbes and Infection, 2000;2(10):1193–1205.

4. Vieira-Damiani G, Diniz PP, Pitassi LH, et al. Bartonella clarridgeiae Bacteremia Detected in an Asymptomatic Blood Donor. Journal of Clinical Microbiology, 2014;53(1):352–356.

5. Maggi RG, Kosoy MY, Mintzer M, et al. Isolation of Candidatus Bartonella melophagi from Human Blood. Emerging Infectious Diseases, 2009;15(1):66–68.

6. Foucault C, Brouqui P, Raoult D. Bartonella quintana Characteristics and Clinical Management. Emerging Infectious Diseases, 2006;12(2):217–223.

7. La VD, Tran-Hung L, Aboudharam G, et al. Bartonella quintana in domestic cat. Emerging Infectious Diseases, 2005;11(8):1287–1289.

8. Cotté V, Bonnet S, Le Rhun D, et al. Transmission of Bartonella henselae by Ixodes ricinus. Emerging Infectious Diseases, 2008;14(7):1074–1080.

9. Chamberlin J, Laughlin LW, Romero S, et al. Epidemiology of Endemic Bartonella bacilliformis: A Prospective Cohort Study in a Peruvian Mountain Valley Community. The Journal of Infectious Diseases, 2002;186(7):983–990.

10. Melter O, Hercík K, Weyant RS, et al. Detection and characterization of feline Bartonella henselae in the Czech Republic. Veterinary Microbiology, 2003,93(3):261–273.

11. Hercík K, Hášová V, Janeček J, et al. Molecular Evidence of Bartonella DNA in Ixodid Ticks in Czechia. Folia Microbiologica, 2007,52(5):503–509.

12. Melter O, Arvand M, Votýpka, et al. Bartonella quintana Transmission from Mite to Family with High Socioeconomic Status. Emerging Infectious Diseases, 2012,18(1):163–165.

13. Orsag J, Flodr P, Melter O, et al. Cutaneous bacillary angiomatosis due to Bartonella quintana in a renal transplant recipient. Transplant International, 2015,28(5):626–631.

14. Džupová O, Peková S, Sojková N, et al. Infective endocarditis due to Bartonella quintana: a severe disease and underdiagnosed etiology. Folia Microbiologica, 2013,58:491–494.

15. Máslová L, Martinková I, Vašutová M. Bartonelóza – nemoc z kočičího škrábnutí. Interní medicína pro praxi, 2014,16(4):167–168.

16. Florin TA, Zaoutis TE, Zaoutis LB. Beyond Cat Scratch Disease: Widening Spectrum of Bartonella henselae Infection. Pediatric, 2008,121(5):1413–1425.

17. Psarros G, Riddell J 4th, Gandhi T, et al. Bartonella henselae Infections in Solid Organ Transplant Recipients Report of 5 Cases and Review of the Literature. Medicine, 2012;91(2):111–121.

18. Manfredi R, Sabbatani S, Chiodo F. Bartonellosis: light and shadows in diagnostic and therapeutic issues. Clinical Microbiology and Infection, 2005;11(3):167–169.

19. Mazur-Melewska K, Mania A, Kemnitz P, et al. Cat-scratch disease: a wide spectrum of clinical pictures. Advances in Dermatology and Allergology, 2015;32(3):216–220.

20. Dimopoulos S, Eleftherakis E, Charitos C, et al. Bartonella quintana Endocarditis as a Cause of Severe Aortic Insufficiency and Heart Failure. Hellenic Journal of Cardiology, 2012;53:476–479.

21. Edouard S, Nabet C, Lepidi H, et al. Bartonella, a Common Cause of Endocarditis: a Report on 106 Cases and Review. Journal of Clinical Microbiology, 2015;53(3):824–829.

22. Habib G, Hoen B, Tornos P, et al. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). European Heart Journal, 2009;30(19):2369–2413.

23. Fournier PE, Thuny F, Richet H, et al. Comprehensive Diagnostic Strategy for Blood Culture-Negative Endocarditis: A Prospective Study of 819 New Cases. Clinical Infectious Diseases, 2010;51(2):131–140.

24. Raoult D, Roblot F, Rolain JM, et al. First Isolation of Bartonella alsatica from a Valve of a Patient with Endocarditis. Journal of Clinical Microbiology, 2006;44(1):278–279.

25. Lin EY, Tsigrelis C, Baddour LM, et al. Candidatus Bartonella mayotimonensis and Endocarditis. Emerging Infectious Diseases, 2010;16(3):500–503.

26. Daly JS, Worthington MG, Brenner DJ, et al. Rochalimaea elizabethae sp. nov. isolated from a patient with endokarditis. Journal of Clinical Microbiology, 1993;31(4):872–881.

27. Roux V, Eykyn SJ, Wyllie S, et al. Bartonella vinsonii subsp. berkhoffii as an Agent of Afebrile Blood Culture-Negative Endocarditis in a Human. Journal of Clinical Microbiology, 2000;38(4):1698–1700.

28. Olarte L, Ampofo K, Thorell EA, et al. Bartonella vinsonii Endocarditis in an Adolescent With Congenital Heart Disease. The Pediatric Infectious Disease Journal, 2012;31(5):531–534.

29. Fenollar F, Sire S, Raoult D. Bartonella vinsonii subsp. arupensis as an Agent of Blood Culture-Negative Endocarditis in a Human. Journal of Clinical Microbiology, 2005;43(2):945–947.

30. Avidor B, Graidy M, Efrat G, et al. Bartonella koehlerae, a New Cat-Associated Agent of Culture-Negative Human Endocarditis. Journal of Clinical Microbiology, 2004;42(8):3462–3468.

31. Jeanclaude D, Godmer P, Leveiller D, et al. Bartonella alsatica endocarditis in a French patient in close contact with rabbits. Clinical Microbiology and Infection, 2009;15(2):110-111.

32. Vikram HR, Bacani AK, DeValeria PA, et al. Bivalvular Bartonella henselae Prosthetic Valve Endocarditis. Journal of Clinical Microbiology, 2007;45(12):4081–4084.

33. Fournier PE, Lelievre H, Eykyn SJ, et al. Epidemiologic and Clinical Characteristics of Bartonella quintana and Bartonella henselae Endocarditis: A study of 48 Patients. Medicine, 2001;80(4):245–251.

34. La Scola B, Raoult D. Culture of Bartonella quintana and Bartonella henselae from Human Samples: a 5-Year Experience (1993 to 1998). Journal of Clinical Microbiology, 1999;37(6):1899–1905.

35. Diddi K, Chaudhry R, Sharma N, et al. Strategy for identification & characterization of Bartonella henselae with conven-
tional & molecular methods. Indian Journal of Medical Research, 2013;137(2):380–387.

36. Maggi RG, Duncan AW, Breitschwerdt EB. Novel Chemically Modified Liquid Medium That Will Support the Growth of Seven Bartonella Species. Journal of Clinical Microbiology, 2005;43(6):2651–2655.

37. Zeaiter Z, Fournier PE, Greub G, et al. Diagnosis of Bartonella Endocarditis by a Real-Time Nested PCR Assay Using Serum. Journal of Clinical Microbiology, 2003;41(3):919–925.

38. Chakravorty S, Helb D, Burday M, et al. 2007. A detailed analysis of 16S ribosomal RNA gene segments for the diagnosis of pathogenic bakteria. Journal of Microbiological Methods, 2007;69(2):330–339.

39. Diaz MH, Bai Y, Malajka L, et al. Development of a Novel Genus--Specific Real-Time PCR Assay for Detection and Differentiation of Bartonella Species and Genotypes. Journal of Clinical Microbiology, 2012;50(5):1645–1649.

40. Avidor B, Kletter Y, Abulafia S, et al. Molecular Diagnosis of Cat Scratch Disease: a Two-Step Approach. Journal of Clinical Microbiology, 1997;35(8):1924–1930.

41. Anderson B, Sims K, Regnery R, et al. Detection of Rochalimaea henselae DNA in Specimens from Cat Scratch Disease Patients by PCR. Journal of Clinical Microbiology, 1994;32(4):942–948.

42. Gouriet F, Lepidi H, Habib G, et al. From cat scratch disease to endocarditis, the possible natural history of Bartonella henselae infection. BMC Infectious Diseases, 2007;7:30.

43. Fournier PE, Mainardi JL, Raoult D. Value of Microimmunofluorescence for Diagnosis and Follow-up of Bartonella Endocarditis. Clinical and Vaccine Immunology, 2002;9(4):795–801.

44. Raoult D, Fournier PE, Vandenesch F, et al. Outcome and Treatment of Bartonella Endocarditis. Archives of Internal Medicine, 2003;163(2):226–230.

45. Rolain JM, Brouqui P, Koehler JE, et al. Recommendations for Treatment of Human Infections Caused by Bartonella Species. Antimicrobial Agents and Chemotherapy, 2004;48(6):1921–1933.

46. Prutsky G, Domecq JP, Mori L, et al. Treatment outcomes of human bartonellosis: a systematic review and meta-analysis. International Journal of Infectious Diseases, 2013;17(10):e811–e819.

47. Habib G, Lancellotti P, Antunes MJ, et al. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC) Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). European Heart Journal, 2015;36(44):3075–3128.

48. Linhartová K, Beneš J, Gregor P. Doporučení ESC pro diagnostiku a léčbu infekční endokarditidy, 2015. Souhrn vypracovaný Českou kardiologickou společností. Cor et Vasa, 2016;58:e107–e128.

49. Baddour LM, Wilson WR, Bayer AS, et al. Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications. Circulation, 2015;132(15):1435–1486.

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