背景:巴尔通体是一种虱子传播的细菌,在低资源环境中仍然是心内膜炎的一个被忽视的原因。我们对风险因素的理解,临床表现,和B.quintana心内膜炎的治疗是偏颇的老研究从高收入国家。
方法:我们搜索了PubmedCentral,Medline,Scopus,Embase,EBSCO(CABI)全球卫生,WebofScience和国际试验注册了2023年3月之前发表的文章,其中包含与巴尔通菌心内膜炎相关的术语。我们纳入了包含关于金塔纳B.quintana心内膜炎病例级信息的文章,并提取了与患者人口统计学相关的数据,临床特征,诊断测试,治疗,和结果。
结果:总共确定了975条记录,其中569个重复在筛选前被删除。总的来说,84篇文章有资格列入,总共描述了167例。感染发生在40个不同国家;62例(37.1%)发生在低收入和中等收入国家(LMICs)。不成比例的更多女性和儿科患者来自LMIC。出现心力衰竭的患者(n=70/167[41.9%])多于发烧(n=65/167[38.9%])。从症状发作到出现的平均时间为5.1个月。此外,25.7%的病例(n=43/167)与栓塞相关,最常见于脾脏和大脑;65.5%的抗菌方案包括多西环素。绝大多数病例接受了瓣膜置换手术(n=154/167,[98.0%])。总病死率为9.6%(n=16/167)。
结论:B.Quintana心内膜炎在全球分布,症状发作和表现之间的长时间延迟经常发生。需要提高临床医生的教育和诊断能力,以筛查高危人群并在心内膜炎发展之前确定感染。
Bartonella quintana is a
louse-borne bacterium that remains a neglected cause of endocarditis in low-resource settings. Our understanding of risk factors, clinical manifestations, and treatment of B. quintana endocarditis are biased by older studies from high-income countries.
We searched Pubmed Central, Medline, Scopus, Embase, EBSCO (CABI) Global Health, Web of Science and international trial registers for articles published before March 2023 with terms related to Bartonella quintana endocarditis. We included articles containing case-level information on B. quintana endocarditis and extracted data related to patient demographics, clinical features, diagnostic testing, treatment, and outcome.
A total of 975 records were identified, of which 569 duplicates were removed prior to screening. In total, 84 articles were eligible for inclusion, describing a total of 167 cases. Infections were acquired in 40 different countries; 62 cases (37.1%) were acquired in low- and middle-income countries (LMICs). Disproportionately more female and pediatric patients were from LMICs. More patients presented with heart failure (n = 70/167 [41.9%]) than fever (n = 65/167 [38.9%]). Mean time from symptom onset to presentation was 5.1 months. Also, 25.7% of cases (n = 43/167) were associated with embolization, most commonly to the spleen and brain; 65.5% of antimicrobial regimens included doxycycline. The vast majority of cases underwent valve replacement surgery (n = 154/167, [98.0%]). Overall case fatality rate was 9.6% (n = 16/167).
B. quintana endocarditis has a global distribution, and long delays between symptom onset and presentation frequently occur. Improved clinician education and diagnostic capacity are needed to screen at-risk populations and identify infection before endocarditis develops.