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Bartonella Species Infections Research · Journal article
Cureus · September 1, 2026
Early or partial results. Treat as a signal, not a conclusion.
This case report documents an incidental diagnosis of Bartonella quintana infective endocarditis detected during pre-TAVI cardiac imaging in an 84-year-old man without classical epidemiological risk factors. The patient presented with a peri-annular abscess on CT, high-titer Bartonella serology, and prolonged blood culture growth, meeting Duke-ISCVID criteria for definite IE; he died of multiorgan failure despite antimicrobial therapy, with TAVI deferred. The report emphasizes the diagnostic challenge of occult Bartonella IE in atypical presentations and the importance of investigating unexpected peri-annular abnormalities during pre-TAVI workup.
Case report. Single 84-year-old man with severe calcific aortic stenosis evaluated for TAVI; no documented classical risk factors for Bartonella infection.. Intervention: Pre-TAVI cardiac CT imaging and serological testing; targeted antimicrobial therapy.. n = 1.
84-year-old man with severe calcific aortic stenosis undergoing pre-TAVI evaluation incidentally found to have peri-annular cavity on cardiac CT consistent with drained or healed peri-annular abscess Initial blood cultures were negative; high-titer Bartonella serology prompted readmission and TAVI deferral Prolonged incubation of blood cultures subsequently identified B. quintana; brain MRI revealed lesion suspicious for intracranial infectious aneurysm
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Clinicians should maintain suspicion for occult Bartonella IE in patients with unexpected peri-annular imaging abnormalities during pre-TAVI workup, even in the absence of fever, classical risk factors, or positive initial blood cultures. This case underscores the diagnostic challenge of blood culture-negative IE and the value of serological testing and prolonged culture incubation when imaging suggests infection.
A single case report describing an unusual diagnostic scenario without comparative data, mechanistic insights, or outcome generalizable beyond the individual patient.
As stated by the source record.
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Clinicians should maintain suspicion for occult Bartonella IE in patients with unexpected peri-annular imaging abnormalities during pre-TAVI workup, even in the absence of fever, classical risk factors, or positive initial blood cultures. This case underscores the diagnostic challenge of blood culture-negative IE and the value of serological testing and prolonged culture incubation when imaging suggests infection.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Bartonella infective endocarditis (IE) is a rare cause of initially blood culture-negative IE, classically associated with cat flea exposure in Bartonella henselae infection or body lice infestation among individuals experiencing homelessness or alcoholism in Bartonella quintana infection.We report the case of an 84-yearold man with severe calcific aortic stenosis who was undergoing evaluation for pre-transcatheter aortic valve implantation (TAVI).Cardiac computed tomography (CT) unexpectedly revealed a peri-annular cavity consistent with a drained or healed peri-annular abscess, despite the absence of fever or other clinical features of IE.Initial blood cultures were negative, and TAVI was planned following multidisciplinary discussion, pending serological results.However, a subsequently reported high-titer Bartonella serology prompted readmission, and TAVI was ultimately deferred after the diagnosis was confirmed.Prolonged incubation of blood cultures subsequently identified B. quintana, while brain magnetic resonance imaging (MRI) revealed a lesion suspicious for an intracranial infectious aneurysm.Definite IE was established according to the 2023 Duke-International Society for Cardiovascular Infectious Diseases (Duke-ISCVID) criteria based on two major criteria: high-titer Bartonella serology and imaging evidence of a peri-annular abscess.No classical epidemiological risk factors for Bartonella infection were identified.Despite targeted antimicrobial therapy, the patient experienced progressive clinical deterioration, and multiple comorbidities precluded surgical intervention.He ultimately died of multiorgan failure.This case highlights the diagnostic challenge of occult B. quintana IE incidentally identified during pre-TAVI evaluation, including in patients without classical epidemiological risk factors or overt manifestations of infection.It also emphasizes that unexpected peri-annular abnormalities detected during pre-TAVI evaluation should prompt a thorough investigation for IE, even in clinically unsuspected cases, with direct implications for procedural planning.
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