The patient was a 43-year-old woman with a history of aortic valvulopathy of probable relapsing origin.
Among the epidemiological background, the patient was a homemade resident and had habitual contact with animals, including cats.
He was admitted to the hospital in March 1998 due to intermittent fever of 6 weeks duration and dark urine output from a month before.
During the examination, the patient was sweating and febrile (37.7o C), with cutaneous manifestations, heart rate of 120 pulses per minute, and auscultation revealed a rough systolic murmur in the aortic area.
In the blood analysis performed on admission, a VSG of 99/h, hematocrit of 25% and hemoglobin of 8.64 gr/l stood out, with normal results for tests and biochemical tests.
The chest X-ray showed cardiomegaly.
The echocardiogram showed a left ventricle with hypertrophy, highlighting thickened aortic valve, calcified, with very echogenic small masses (vegetations) that functioned as a double aortic lesion with moderate stenosis and severe aortic insufficiency.
Transesophageal ultrasound showed mild mitral regurgitation and small masses in the septal valve.
The hemodynamic study revealed severe double aortic lesion.
No mitral regurgitation or images suggestive of abscesses were observed.
The hemocultives obtained from this patient were negative, both the aerobic bottle and the anaerobic bottle, after fixation for 1 month (Bactectec 9240, Becton Dickinson Microbks System, USA).
In a sample of serum extracted in the first days of admission an IgG titer against B. henselae of 1/4096 and 1/256 against B. quintana (Bpress MRP CyFA).
After absorption of IgG with human anti-IgG (RF Absorbens, Boehringwerke, Munich, Germany) IgM was detected against B. henselae IgM titer and weak B. quintana.
No antibodies against Coxiella burni, Chlamydia trachomatis, C. psittaci, Legionella pneuma Mycoplasma pneumoniae, Brucella spp, Salmonella spp., Streptococcus pneumoniae (I weak against Salmonella spp.) were detected.
The patient was initially treated with ampicillin and gentamicin.
The serological results and the suspicion of endocarditis due to B. hensee were changed to ciprofloxacin and the positive diagnosis and treatment obtained.
Six weeks after starting treatment, valve replacement with a mechanical prosthesis was performed due to the severe lesion in the aortic valve.
Antibiotic treatment was continued for 6 more weeks, being currently the asymptomatic patient (14 months after the episode of endocarditis).
Anatomopathological examination of the aortic valve showed multifocal fibrosis, calcification, and leukocyte infiltration.
DNA (QIAamp tissue kit, Qiagen, Germany) was extracted from the samples of endocardial tissue (resected aortic valve). DNA was extracted from these samples using an unknown amplification test of DNA bases using a fifth polymerase chain reaction (10).
The hybridization of the amplified fragment with specific RQ1, RH1 and RE1 probes of the three referred Bartonella species was positive in this case only with the specific probe of B. henselae.
