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Bartonella and Coxiella infections presenting as systematic vasculitis:…

- - - - responsible for 1-4% of endocarditis in certain areas.
- - - - Show clinical manifestations of vasculitis
        
        purpura
        
        Arthralgia
        
        myalgia
        
        Kidney involvement
        
        peripheral neuropathy
      - ANCA or cryoglobulinema positivity
      - Radiological imaging
        
        CT
        
        PET - CT
        
        MRI
        
        Angiography
      - Histological features
        
        leukocytoclastic
        
        granulomatous or necrotizing vasculitis
        
        crescentric glomerulonephritis
      - proven Coxiella and Bartonella infection
        
        positive serology
        
        Positive PCR
        
        Positive cultures
- - - - 67% of patients were men
      - 54% had pre-existing valvuopathy or prosthetic valve
      - 88% had negative blood culture for common infectious endocarditis
      - Bartonella was documented by serology in 79% of cases
        
        92% were IgG positive
        
        80% IgM positive
        
        by PCR
        
        38% on excised tissue
        
        17% in blood samples
      - Bartonella mimicked AAV in 83% of cases
      - All cases treated with immunosuppressives alone without antibiotic treatment relapsed or deteriorated
      - No microbial DNA was detected in tissue through NGS
      - Main symptoms were fever, purpura and arthralgia, with kidney involvement in 92% of cases