BARTONELLA-QUITANA - AORTIC LOCALIZATION AND MITRAL ABSCESS

Bartonella Quintana is an exceptionally rare cause of endocarditis. Th e frequency of this condition is increasing and is probably underestim ated because of the difficulty in diagnosing. The clinical context is that of socially deprived classes, the agent of transmission of the ge rm being body lice. The commonest valve affected is the aortic valve. This infection may also give rise to a mitral annulus abscess, as in t his particular case. The diagnosis should be suspected in all cases of endocarditis with negative blood cultures in socially deprived patien ts as special diagnostic methods are required. Bartonellosis serology and drainage of effusions to perform a Gimenez stain to show intra-cel lular bacteria and a polymerase chain reaction to sequence the nucleic acids, will give an accurate diagnosis. Similarly, the operative spec imens should be sent to a specialised department for the culture of th ese bacteria (in France, the Marseille Ricketsioses Institute). The tr eatment of Bartonella endocarditis is very controversial. The usual re commendations are an association of betalactamines and an aminoside fo r one month and macrolides or tetracyclines. There is lack of consensu s about follow-up. It would seem prudent to perform a clinical examina tion to search for a relapse of the infection and monthly serologies u ntil they return to normal values.