SUMMARY Since the reclassification of the genus Bartonella in 1993, the number of species has grown from 1 to 45 currently designated members. Likewise, the association of different Bartonella species with human disease continues to grow, as does the range of clinical presentations associated with these bacteria. Among these, blood-culture-negative endocarditis stands out as a common, often undiagnosed, clinical presentation of infection with several different Bartonella species. The limitations of laboratory tests resulting in this underdiagnosis of Bartonella endocarditis are discussed. The varied clinical picture of Bartonella infection and a review of clinical aspects of endocarditis caused by Bartonella are presented. We also summarize the current knowledge of the molecular basis of Bartonella pathogenesis, focusing on surface adhesins in the two Bartonella species that most commonly cause endocarditis, B. henselae and B. quintana. We discuss evidence that surface adhesins are important factors for autoaggregation and biofilm formation by Bartonella species. Finally, we propose that biofilm formation is a critical step in the formation of vegetative masses during Bartonella-mediated endocarditis and represents a potential reservoir for persistence by these bacteria.

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巴尔通体物种，血液培养阴性心内膜炎的新兴原因[评论]

总结自从1993年对巴尔通体属进行重新分类以来，该物种的数量已从1个增加到45个当前指定的成员。同样，不同的巴尔通体物种与人类疾病的关联也在不断增长，与这些细菌有关的临床表现范围也在不断增长。其中，血液培养阴性心内膜炎是常见的，通常未经诊断的临床表现，感染了几种不同的巴尔通体。讨论了导致Bartonella心内膜炎诊断不足的实验室检查的局限性。巴尔通体感染的临床表现各异，并回顾了心内膜炎引起的心内膜炎的临床方面介绍了巴尔通体。我们也总结的分子基础的现有知识巴尔发病机制，着眼于表面粘附在两巴尔种，最常见的原因心内膜炎，B.通体和B.通体。我们讨论的证据表明，表面粘附素是Bartonella菌种自动聚集和生物膜形成的重要因素。最后，我们提出生物膜形成是巴尔通体介导的心内膜炎期间营养物质形成的关键步骤，并代表这些细菌持续存在的潜在库。