Case Study

A 46-year-old homeless male with a history of excessive alcohol consumption presented to the emergency department with a two-week history of fever and night sweats. The diagnosis of infective endocarditis was considered when he was found to have a systolic ejection murmur in the aortic area as well as an early diastolic murmur along the left sternal border. A transthoracic echocardiogram revealed an aortic valve vegetation with moderate aortic regurgitation. Two sets of blood cultures drawn prior to initiation of intravenous ceftriaxone and vancomycin yielded no growth after extended incubation in the microbiology laboratory. Valve tissue obtained at the time of aortic valve replacement was sterile despite five days of culture. Polymerase chain reaction (PCR) of the 16S-23S rDNA intergenic spacer region with sequencing of the PCR product confirmed the causative agent to be Bartonella quintana.

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Booze Basher

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