Bartonella quintana infective endocarditis in a homeless man with unexpected positive blood culture

Bartonella species represent important causative agents of blood culture-negative infective endocarditis (IE). Their diagnosis represents a challenge for microbiologists and often relies on serological and molecular tools. However, even if the sensitivity of blood culture remains low, it should not be definitely ruled out. Indeed, we report the unusual case of a 22 year-old Guinean homeless man diagnosed with an IE due to Bartonella quintana. Unexpectedly, conventional blood cultures were positive after 13 days of incubation. Subculture was obtained on blood and chocolate agar, after 15 days of incubation in a 5 % CO2 atmosphere. Bacterial identification was obtained up to the species level using molecular tools (16S rRNA gene amplification and sequencing). A literature review of B. quintana blood culture-positive IE was conducted and revealed eighteen similar reported cases on a 25-year period. This case illustrates that, despite low sensitivity, Bartonella IE may be diagnosed thanks to prolonged blood culture.