文森巴尔通体致人类感染性心内膜炎1例报告并文献复习

Human infective endocarditis caused by Bartonella vinsonii subsp. berkhoffii: one case report and literature review

摘要:

目的 探讨文森巴尔通体博格霍夫亚种(Bvb)所致感染性心内膜炎的临床特点及诊疗策略。方法 报告国内1例25岁男性感染Bvb导致心内膜炎患者的临床诊治经过,同时结合国外报道的3例相似案例文献资料进行总结分析。结果 4例患者均为青壮年男性,既往1年内有犬类动物密切接触史;以胸痛、疲乏、呼吸困难为主要症状,合并脑血管意外及严重贫血,有心脏瓣膜赘生物形成及瓣膜功能损伤;多次血培养阴性,2例经病原微生物宏基因组二代测序技术(mNGS),3例经聚合酶链反应明确为Bvb感染。患者均因心力衰竭接受手术治疗,经手术及针对性抗感染治疗后患者均存活。结论 本例报告为国内首例Bvb感染性心内膜炎病例。患者经血清学间接免疫荧光分析法(IFA)及NGS明确诊断,手术结合抗感染治疗效果理想。

Abstract:

Objective To explore the clinical characteristics and treatment strategies of infective endocarditis caused by Bartonella vinsonii subsp. berkhoffii (Bvb). Methods Clinical diagnosis and treatment of a 25-year-old male patient with infective endocarditis caused by Bvb in China was reported, combined with literatures about three similar cases reported abroad were summarized and analyzed. Results All 4 patients were young and middle-aged males with a history of close contact with canines in the past one year. The main symptoms were chest pain, fatigue, and dyspnea, accompanied by cerebrovascular accidents and severe anemia, as well as the formation of heart valve vegetations and valve function impairment. Multiple blood cultures were negative, 2 and 3 cases were confirmed to be infected with Bvb through metagenomic next-generation sequencing (mNGS) of pathogenic microorga-nisms and polymerase chain reaction respectively. All patients underwent surgical treatment due to heart failure, and all survived after surgery and targeted anti-infective treatment. Conclusion This case report is the first case of Bvb infective endocarditis in China. Patient’s diagnosis is confirmed by serum indirect immunofluorescence assay and mNGS, combination of surgery and anti-infective treatment has achieved ideal effect.