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Bartonella henselae endocarditis in Laos - 'the unsought will go undetected'.

Rattanavong S, Fournier PE, Chu V, Frichitthavong K, Kesone P, Mayxay M, Mirabel M, Newton PN - PLoS Negl Trop Dis (2014)

Bottom Line: Both endocarditis and Bartonella infections are neglected public health problems, especially in rural Asia.In view of the strong suspicion of infective endocarditis, acute and convalescent sera from 30 patients with culture negative endocarditis were tested for antibodies to Brucella melitensis, Mycoplasma pneumoniae, Bartonella quintana, B. henselae, Coxiella burnetii and Legionella pneumophila.Considering the high prevalence of rheumatic heart disease in Asia, there is remarkably little evidence on the bacterial etiology of endocarditis.

View Article: PubMed Central - PubMed

Affiliation: Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic.

ABSTRACT

Background: Both endocarditis and Bartonella infections are neglected public health problems, especially in rural Asia. Bartonella endocarditis has been described from wealthier countries in Asia, Japan, Korea, Thailand and India but there are no reports from poorer countries, such as the Lao PDR (Laos), probably because people have neglected to look.

Methodology/principal findings: We conducted a retrospective (2006-2012), and subsequent prospective study (2012-2013), at Mahosot Hospital, Vientiane, Laos, through liaison between the microbiology laboratory and the wards. Patients aged >1 year admitted with definite or possible endocarditis according to modified Duke criteria were included. In view of the strong suspicion of infective endocarditis, acute and convalescent sera from 30 patients with culture negative endocarditis were tested for antibodies to Brucella melitensis, Mycoplasma pneumoniae, Bartonella quintana, B. henselae, Coxiella burnetii and Legionella pneumophila. Western blot analysis using Bartonella species antigens enabled us to describe the first two Lao patients with known Bartonella henselae endocarditis.

Conclusions/significance: We argue that it is likely that Bartonella endocarditis is neglected and more widespread than appreciated, as there are few laboratories in Asia able to make the diagnosis. Considering the high prevalence of rheumatic heart disease in Asia, there is remarkably little evidence on the bacterial etiology of endocarditis. Most evidence is derived from wealthy countries and investigation of the aetiology and optimal management of endocarditis in low income countries has been neglected. Interest in Bartonella as neglected pathogens is emerging, and improved methods for the rapid diagnosis of Bartonella endocarditis are needed, as it is likely that proven Bartonella endocarditis can be treated with simpler and less expensive regimens than "conventional" endocarditis and multicenter trials to optimize treatment are required. More understanding is needed on the risk factors for Bartonella endocarditis and the importance of vectors and vector control.

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Related in: MedlinePlus

Western blot performed from the first patient's serum before and after cross-adsorption.WM = Weight marker; lanes 1, 3 and 5: B. quintana antigen; lanes 2, 4 and 6: B. henselae antigen; lanes 1 and 2: unadsorbed serum; lanes 3 and 4: serum adsorbed with B. henselae; lanes 5 and 6: serum adsorbed with B. quintana.
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pntd-0003385-g001: Western blot performed from the first patient's serum before and after cross-adsorption.WM = Weight marker; lanes 1, 3 and 5: B. quintana antigen; lanes 2, 4 and 6: B. henselae antigen; lanes 1 and 2: unadsorbed serum; lanes 3 and 4: serum adsorbed with B. henselae; lanes 5 and 6: serum adsorbed with B. quintana.

Mentions: In 2012 a previously healthy 57-year-old army officer from Pakse, southern Laos, was admitted with one month of fever, headache, myalgia, back pain, productive cough and 4 days of chills and dyspnea. On examination he was afebrile, normotensive but with a pansystolic (3/6) murmur at the mitral and tricuspid areas with clear lungs and no peripheral signs of endocarditis. His admission peripheral blood count was white blood count (WBC) 7.2×109/L, haemoglobin 7.4 g/dL, mean cell volume 79 fL, mean cell haemoglobin 24.6 pg and platelets 159×109/L. Transthoracic echocardiogram showed a vegetation on the mitral valve (maximum length 1.9 cm), with mild mitral regurgitation, mild aortic and tricuspid valve regurgitation. Three sets of blood cultures incubated for 7 days showed no growth. The patient exhibited IgG titers of 1∶400 to both B. henselae and B. quintana in acute serum, and then 1∶200 in the convalescent serum. He also had a specific Western blot profile for B. henselae endocarditis (Fig. 1). He was treated with intravenous ceftriaxone 2 g once a day for 6 weeks and gentamicin 240 mg/d for 2 weeks and was well at one year follow up.


Bartonella henselae endocarditis in Laos - 'the unsought will go undetected'.

Rattanavong S, Fournier PE, Chu V, Frichitthavong K, Kesone P, Mayxay M, Mirabel M, Newton PN - PLoS Negl Trop Dis (2014)

Western blot performed from the first patient's serum before and after cross-adsorption.WM = Weight marker; lanes 1, 3 and 5: B. quintana antigen; lanes 2, 4 and 6: B. henselae antigen; lanes 1 and 2: unadsorbed serum; lanes 3 and 4: serum adsorbed with B. henselae; lanes 5 and 6: serum adsorbed with B. quintana.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4263471&req=5

pntd-0003385-g001: Western blot performed from the first patient's serum before and after cross-adsorption.WM = Weight marker; lanes 1, 3 and 5: B. quintana antigen; lanes 2, 4 and 6: B. henselae antigen; lanes 1 and 2: unadsorbed serum; lanes 3 and 4: serum adsorbed with B. henselae; lanes 5 and 6: serum adsorbed with B. quintana.
Mentions: In 2012 a previously healthy 57-year-old army officer from Pakse, southern Laos, was admitted with one month of fever, headache, myalgia, back pain, productive cough and 4 days of chills and dyspnea. On examination he was afebrile, normotensive but with a pansystolic (3/6) murmur at the mitral and tricuspid areas with clear lungs and no peripheral signs of endocarditis. His admission peripheral blood count was white blood count (WBC) 7.2×109/L, haemoglobin 7.4 g/dL, mean cell volume 79 fL, mean cell haemoglobin 24.6 pg and platelets 159×109/L. Transthoracic echocardiogram showed a vegetation on the mitral valve (maximum length 1.9 cm), with mild mitral regurgitation, mild aortic and tricuspid valve regurgitation. Three sets of blood cultures incubated for 7 days showed no growth. The patient exhibited IgG titers of 1∶400 to both B. henselae and B. quintana in acute serum, and then 1∶200 in the convalescent serum. He also had a specific Western blot profile for B. henselae endocarditis (Fig. 1). He was treated with intravenous ceftriaxone 2 g once a day for 6 weeks and gentamicin 240 mg/d for 2 weeks and was well at one year follow up.

Bottom Line: Both endocarditis and Bartonella infections are neglected public health problems, especially in rural Asia.In view of the strong suspicion of infective endocarditis, acute and convalescent sera from 30 patients with culture negative endocarditis were tested for antibodies to Brucella melitensis, Mycoplasma pneumoniae, Bartonella quintana, B. henselae, Coxiella burnetii and Legionella pneumophila.Considering the high prevalence of rheumatic heart disease in Asia, there is remarkably little evidence on the bacterial etiology of endocarditis.

View Article: PubMed Central - PubMed

Affiliation: Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic.

ABSTRACT

Background: Both endocarditis and Bartonella infections are neglected public health problems, especially in rural Asia. Bartonella endocarditis has been described from wealthier countries in Asia, Japan, Korea, Thailand and India but there are no reports from poorer countries, such as the Lao PDR (Laos), probably because people have neglected to look.

Methodology/principal findings: We conducted a retrospective (2006-2012), and subsequent prospective study (2012-2013), at Mahosot Hospital, Vientiane, Laos, through liaison between the microbiology laboratory and the wards. Patients aged >1 year admitted with definite or possible endocarditis according to modified Duke criteria were included. In view of the strong suspicion of infective endocarditis, acute and convalescent sera from 30 patients with culture negative endocarditis were tested for antibodies to Brucella melitensis, Mycoplasma pneumoniae, Bartonella quintana, B. henselae, Coxiella burnetii and Legionella pneumophila. Western blot analysis using Bartonella species antigens enabled us to describe the first two Lao patients with known Bartonella henselae endocarditis.

Conclusions/significance: We argue that it is likely that Bartonella endocarditis is neglected and more widespread than appreciated, as there are few laboratories in Asia able to make the diagnosis. Considering the high prevalence of rheumatic heart disease in Asia, there is remarkably little evidence on the bacterial etiology of endocarditis. Most evidence is derived from wealthy countries and investigation of the aetiology and optimal management of endocarditis in low income countries has been neglected. Interest in Bartonella as neglected pathogens is emerging, and improved methods for the rapid diagnosis of Bartonella endocarditis are needed, as it is likely that proven Bartonella endocarditis can be treated with simpler and less expensive regimens than "conventional" endocarditis and multicenter trials to optimize treatment are required. More understanding is needed on the risk factors for Bartonella endocarditis and the importance of vectors and vector control.

Show MeSH
Related in: MedlinePlus