Backgound: Bartonella quintana endocarditis infections have very rarely been reported in children and have been currently described in only one microbiologically confirmed case.
Material and Methods: This case series presents 4 pediatric patients from Ethiopia with B.quintana endocarditis and one child with bartonella species endocarditis and reviews the literature.
Results: During 2006-2015 7 children with heart defects from Africa were diagnosed with infective endocarditis prior to their operation. The most frequent causative organism was B.quintana diagnosed in 4 children. There was one case of bartonella species, 1 case of Q fever and 1 case of Streptococcus viridans endocarditis. B.quintana endocarditis manifested without fever, with normal to slightly elevated CRP, and elevated sedimentation rate, and severe heart failure. Endocarditis in these patients was not suspected on clinical grounds but diagnosis was pursued after demonstration of vegetations on echocardiography and identification of B. quintana DNA in the excised vegetations. Embolic events were diagnosed in 2 patients.
Conclusion: These cases underscore the insidious presentation, the potential of large vegetations, and the destructive course associated with B.quinatana endocarditis, and present the challenges in its clinical, diagnostic and therapeutic management. Our data suggest that B.quintana endocarditis is a frequent causative organism of pre - operative endocarditis in African children with heart disease and suggests that B.quintana should be suspected and pursued in East Africa residents and immigrants or travelers from East Africa/Ethiopia with culture-negative endocarditis.
