# Bartonella Endocarditis in a Pediatric Patient With Aortic Valvular Disease and Embolic Stroke: A Case Report and Review of the Literature

## TL;DR

A 12-year-old boy with a heart valve condition developed a rare Bartonella infection causing endocarditis and stroke, diagnosed using advanced DNA testing and successfully treated with adjusted antibiotics.

## Contribution

Demonstrates the utility of microbial cell-free DNA testing in diagnosing culture-negative Bartonella endocarditis in a pediatric patient.

## Key findings

- Bartonella henselae endocarditis was diagnosed using plasma microbial cell-free DNA testing in a patient with culture-negative results.
- Second-line antimicrobials led to significant clinical improvement and neurological recovery within three weeks.
- The case highlights the importance of advanced diagnostic methods for challenging infections in pediatric cardiology.

## Abstract

Culture-negative endocarditis leading to embolic stroke is a rare clinical etiology in pediatrics. This is a case of a 12-year-old male with a history of bicuspid aortic valve and mild asymptomatic aortic stenosis who presented with flu-like symptoms, right-sided hemiplegia, and aphasia. Although he initially presented with symptoms of arterial ischemic stroke, he was found to have infective endocarditis (IE) secondary to Bartonella henselae, confirmed by echocardiogram and plasma microbial cell-free DNA (mcf-DNA) testing. Initial antimicrobial treatment per standard guidelines was unsuccessful. Hence, second-line antimicrobials were commenced, to which he responded appropriately. His clinical course markedly improved, with recovery of neurological function within three weeks. He continued treatment of endocarditis and bartonellosis in an outpatient setting with significant clinical response until eventual cardiac surgery for valve replacement. Although the diagnosis and management of blood culture-negative IE can be very challenging and associated with morbidity, mcf-DNA testing has been shown to be helpful in establishing an accurate diagnosis and promoting appropriate antimicrobial management.