Fever of unknown origin and splenomegaly: A case report of blood culture negative endocarditis.

Burzo ML, et al. Medicine (Baltimore). 2017.


RATIONALE: Fever of unknown origin (FUO) can be determined by different conditions among which infectious diseases represent the main cause.

PATIENT CONCERNS: A young woman, with a history of aortic stenosis, was admitted to our unit for a month of intermittent fever associated with a new diastolic heart murmur and splenomegaly. Laboratory tests were negative for infectious screening. The total body computed tomography (CT) scan excluded abscesses, occulted neoplasia, or lymphadenopathy.

DIAGNOSES: The transthoracic and transesophageal echocardiogram showed an aortic valve vegetation. Three sets of blood cultures were negative for all microorganisms tested. According to these findings, Bartonella endocarditis was suspected and the serology tests performed were positive. Finally, real-time polymerase chain reaction (RT-PCR) detected Bartonella henselae DNA on tissue valve.

INTERVENTIONS: The patient underwent heart valve surgery and a treatment of Ampicillin, Gentamicin, and oral Doxycycline was prescribed for 16 days and, successively, with Doxycycline and Ceftriaxone for 6 weeks.

OUTCOMES: After surgery and antibiotic therapy, patient continued to do well.

LESSONS: Bartonella species are frequently the cause of negative blood culture endocarditis. Molecular biology techniques are the only useful tool for diagnosis. Valvular replacement is often necessary and antibiotic regimen with Gentamicin and either Ceftriaxone or Doxycycline is suggested as treatment.Echocardiogram and blood cultures must be performed in all cases of FUO. When blood cultures are negative and echocardiographic tools are indicative, early use of Bartonella serology is recommended.

Great information regarding how difficult it is to pick up microorganisms through testing and the importance of the right test.  This has been the thorn in Lyme/MSIDS patients sides for decades and why so many continue to fall through the cracks.
The Cabal continues to rely on old studies and testing methods which are extremely flawed to make emphatic statements on all things Tick borne illness related.
New tests must be accepted & used.  If it weren’t for the dedicated sleuthing of a doctor, this woman might be dead, and many have succumbed to that outcome due to poor testing, lack of diagnosis, and treatment.
Ticks that transmit Bartonella include Ixodes Scapularis (also called the blacklegged tick or deer tick) and Ixodes Pacificus (western black legged tick), both of which also transmit Lyme disease. More than one co-infection can be transmitted from the same tick bite. A paper by Martin Fried and Aswine Bal, both MD’s,, found it to cause heartburn, abdominal pain, skin rash, gastritis (inflammation of the stomach lining) and duodentis (inflammation of 1st portion of the small intestine) in children and adolescents, as well as mesenteric adenitis (inflammation in abdominal lymph nodes).
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