Bartonella Endocarditis in Spain: Case Reports of 21 Cases

Blood culture negative endocarditis (BCNE) is frequent in infective endocarditis (IE). One of the causes of BCNE is fastidious microorganisms, such as Bartonella spp. The aim of this study was to describe the epidemiologic, clinical characteristics, management and outcomes of patients with Bartonella IE from the “Spanish Collaboration on Endocarditis-Grupo de Apoyo al Manejo de la Endocarditis infecciosa en España (GAMES)”cohort. Here we presented 21 cases of Bartonella IE. This represents 0.3% of a total of 5590 cases and 2% of the BCNE from the GAMES cohort. 62% were due to Bartonella henselae and 38% to Bartonella quintana. Cardiac failure was the main presenting form (61.5% in B. hensalae, 87.5% in B. quintana IE) and the aortic valve was affected in 85% of the cases (76% in B. henselae, 100% in B. quintana IE). Typical signs such as fever were recorded in less than 40% of patients. Echocardiography showed vegetations in 92% and 100% of the patients with B. henselae and B. quintana, respectively. Culture was positive only in one patient and the remaining were diagnosed by serology and PCR. PCR was the most useful tool allowing for diagnosis in 16 patients (100% of the studied valves). Serology, at titers recommended by guidelines, only coincided with PCR in 52.4%. Antimicrobial therapy, in different combinations, was used in all cases. Surgery was performed in 76% of the patients. No in-hospital mortality was observed. One-year mortality was 9.4%. This article remarks the importance for investigating the presence of Bartonella infection as causative agent in all BCNE since the diagnosis needs specific microbiological tools and patients could benefit of a specific treatment

Aproximación clínica a la eosinofilia importada

Formación médica continuada: Salud internacional y atención al viajero.[EN] Eosinophilia is a common finding in international travelers and immigrants, being an helmintic infection its main etiology. The positive predictive value of eosinophilia for an helmintosis is low in travellers. Eosinophilia may be an incidental finding, or symptomatic, and it represents a clinical challenge due to the low sensitivity and specificity of direct and indirect parasitological diagnostic tests, respectively. It requires a structured approach based on geographical areas, environmental exposures and behavioral risks, and associated symptoms. The initial assessment should include a comprehensive and tailored anamnesis and physical examination, basic laboratory tests, a complete parasitological examination of stool samples and a Strongyloides stercoralis serology, supplemented with other explorations guided by epidemiological and clinical suspicion. Empiric treatment with albendazole and/or ivermectin (plus praziquantel if risk of schistosomiasis) is an option for unidentified persistent eosinophilia after study, and in persons in whom a proper assessment or follow-up can not be assured. In patients at risk for estrongiloidosis who are candidates for immunosuppressive therapies, it is indicated a prior screening and treatment to prevent a future hyperinfestation syndrome.[ES] La eosinofilia es frecuente en viajeros e inmigrantes, siendo las helmintosis su principal etiología. El valor predictivo positivo de la eosinofilia para una infección parasitaria es bajo en viajeros. La eosinofilia puede ser un hallazgo incidental o sintomático, y constituye un reto clínico debido a la baja sensibilidad y especificidad de las técnicas parasitológicas directas e indirectas, respectivamente. Requiere una aproximación estructurada basada en áreas geográficas, riesgos de exposición ambientales y conductuales, y síntomas asociados. La evaluación inicial debe incluir anamnesis y exploración física dirigidas, analítica básica, examen coproparasitológico completo y serología de Strongyloides stercoralis, complementada con otras pruebas según procedencia y sospecha clínica. El tratamiento empírico con albendazol y/o ivermectina (más praziquantel si hay riesgo de esquistosomiasis) es una opción en eosinofilias persistentes no filiadas tras estudio, y en personas en las que la evaluación inicial o el seguimiento no se puedan asegurar. En pacientes con riesgo de estrongiloidosis candidatos a inmunodepresión farmacológica está indicado el cribado y tratamiento previo para prevenir el síndrome de hiperinfestación.Peer reviewe