Citation: Drummond MR, de Almeida AR, Valandro L, Pavan MHP, Stucchi RSB, Aoki FH, et al. (2020) Bartonella henselae endocarditis in an elderly patient. PLoS Negl Trop Dis 14(7): e0008376. https://doi.org/10.1371/journal.pntd.0008376
Editor: Joseph M. Vinetz, Yale University School of Medicine, UNITED STATES
Published: July 30, 2020
Copyright: © 2020 Drummond et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: This work was supported by Brazilian National Council for Scientific and Technological Development (CNPq) grant #159717/2013-2 (MRD) and #301900/2015-9 (PENFV). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
We report an 85-year-old white man admitted to the emergency department of the University of Campinas with fever of undetermined origin (FUO) who received antibiotics previously. Initially, the hypothesis was pneumonia. He presented a drug reaction misdiagnosed as staphylococcal desquamation. The follow-up confirmed that prolonged fever was caused by bacterial endocarditis by transthoracic echocardiogram that showed vegetation in the aortic valve. Bartonella henselae etiology was confirmed by PCR.
This case reinforces the difficulty of diagnosing Bartonella sp. infection; this etiology must be considered even in patients with negative serology. The criteria for the diagnosis of bacterial endocarditis should contemplate a molecular positivity investigation for Bartonella spp, such as PCR in blood or serum samples as a major Duke criterion, even if with titers lower than 1 to 800.