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真髄培養陰性心内膜炎
Quintessential Culture-Negative Endocarditis.
PMID: 26342845 DOI: 10.1016/j.cjca.2015.05.027.
抄録
Bartonella sppは培養陰性心内膜炎の重要な原因であり、一般に亜急性陰性型の心内膜炎を引き起こし、しばしば診断の遅れにつながる。ほとんどの患者は発熱を呈し、心不全の徴候や症状を呈することが多い。診断は切除した心臓弁をポリメラーゼ連鎖反応法で精査して初めて確定することが多い。我々はB quintanaの僧帽弁および大動脈弁内膜炎を合併し，重度の弁膜不全とStreptococcus pneumoniae菌血症による心不全を呈し，緊急に外科的な弁置換を必要とした1例を紹介する．弁の病理学的検査と血清学的・分子学的検査の結果，B quintana心内膜炎と診断された．
Bartonella spp are important causes of culture-negative endocarditis, generally causing a subacute insidious form of endocarditis, often leading to a delay in diagnosis. Most patients have fever and often present with signs and symptoms of heart failure. The diagnosis is frequently established only on meticulous examination of the resected heart valve with the polymerase chain reaction technique. We present a case of B quintana mitral and aortic valve endocarditis with associated severe valvular insufficiency and decompensated heart failure precipitated by Streptococcus pneumoniae bacteremia, necessitating urgent surgical valve replacement. Pathologic examination of the valve complemented by serologic and molecular testing established the surprising diagnosis of B quintana endocarditis.
Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.