The Silent Threat: Bartonella quintana Endocarditis Unveiling Heart Failure and Severe Pulmonary Hypertension.
The Silent Threat: Bartonella quintana Endocarditis Unveiling Heart Failure and Severe Pulmonary Hypertension.
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DOI：
10.12659/ajcr.942160
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发表时间：
2023-12-11
影响因子：
1.2
通讯作者：
Chorba, John S.
中科院分区：
文献类型：
--
作者：
Boctor, Daniel;Bakke, Brian;Chorba, John S.
患者：男性，51 岁 最终诊断：心内膜炎 • 肺动脉高压 症状：失语 • 精神错乱 临床程序： — 专业：心脏病学 • 传染病 • 肺病学 罕见疾病或病理共存 五体巴尔通体是一种生长缓慢的革兰氏阴性细菌，可引起严重的培养阴性心内膜炎。在许多情况下，鉴于疾病早期阶段的不同症状，其起病隐匿可能很难诊断。这种检测和治疗的延迟可能会导致该疾病的严重后果，包括心力衰竭和严重肺动脉高压。一名 51 岁男子因出现急性中风的体征和症状而被送往急诊室。进一步调查显示，来源是心源性栓塞，尽管血培养呈阴性，但由于超声心动图检查结果，怀疑是心内膜炎。根据血清学结果诊断巴尔通体心内膜炎。进一步的检查表明存在严重的肺动脉高压，这是心内膜炎引起的慢性心力衰竭的后遗症。这导致瓣膜修复手术的严重延误。该病例说明了从急性感染到慢性感染的过程、该疾病过程的后遗症以及治疗中涉及的注意事项。巴尔通体是心内膜炎的一个未被充分认识的病因，它可以演变成慢性疾病，产生需要细致入微的治疗的临床后果。我们描述了一例慢性培养阴性心内膜炎病例，该病例表现为急性栓塞性卒中和严重多瓣膜疾病的后遗症，患者最近被监禁且住房不稳定。该病例为临床医生提供了宝贵的见解，包括巴尔通体心内膜炎的识别、该病理学的不同临床表现、细致入微且多因素的医疗管理方法以及手术指征。
Patient: Male, 51-year-old Final Diagnosis: Endocarditis • pulmonary hypertension Symptoms: Aphasia • confusion Clinical Procedure: — Specialty: Cardiology • Infectious Diseases • Pulmonology Rare coexistence of disease or pathology Bartonella quintana is a slow-growing gram-negative bacterium that can cause severe culture-negative endocarditis. In many cases, its insidious onset can be difficult to diagnose given the variable symptoms in the early phases of the disease. This delay in detection and thus treatment can cause advanced consequences of the disease, including heart failure and severe pulmonary hypertension. A 51-year-old man presented to the Emergency Department with signs and symptoms indicating an acute stroke. Further investigation showed that the source was cardioembolic, and despite negative blood cultures, endocarditis was suspected due to echocardiogram findings. Bartonella endocarditis was diagnosed based on serology results. Further testing indicated severe pulmonary hypertension, a sequelae of chronic heart failure in the setting of endocarditis. This caused a significant delay in valvular repair surgery. This case illustrates the progression from acute to chronic infection, the sequelae of this disease process, and the considerations involved in management. Bartonella is an under-appreciated cause of endocarditis and can evolve into chronic disease with clinical consequences requiring nuanced management. We described a case of chronic culture-negative endocarditis that presented with acute embolic stroke and the sequelae of severe multi-valvular disease in a patient with recent incarceration and unstable housing. This case provides clinicians with valuable insight into the recognition of Bartonella endocarditis, the variable clinical presentations of this pathology, the nuanced and multifactorial approaches to medical management, and the indications for surgery.