Blood Culture-Negative Endocarditis in a Reference Center

Houpikian, Pierre; Raoult, Didier

doi:10.1097/01.md.0000165658.82869.17

Cited by 403 publications

(276 citation statements)

References 100 publications

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“…In one study, when evaluated in conjunction with blood cultures, systematic serologic testing established an etiological diagnosis in an additional 8% (34/425) of patients (5). In a separate investigation focused on culture-negative endocarditis, serology provided a diagnosis in 77% (268/348) of cases (20). Organisms for which serologic tests have been shown to aid in the diagnosis of endocarditis include C. burnetii and Bartonella species (and, in areas where Brucella endocarditis occurs, Brucella species).…”

Section: Diagnosis Of Culture-negative Endocarditismentioning

confidence: 99%

“…In patients who have not received antibiotics, the most common etiologies of culture-negative endocarditis are C. burnetii and Bartonella species, with the former accounting for 28% to 37% and the latter accounting for 12% to 28% of cases (7,20). T. whipplei causes up to 6% of cases of culture-negative endocarditis (7,20,21).…”

Section: Diagnosis Of Culture-negative Endocarditismentioning

confidence: 99%

“…T. whipplei causes up to 6% of cases of culture-negative endocarditis (7,20,21). C. acnes, a rare cause of endocarditis, may cause culture-negative endocarditis due to the requirement for prolonged blood culture incubation for growth of some strains (14); in addition, some strains may not grow in blood cultures.…”

Section: Diagnosis Of Culture-negative Endocarditismentioning

confidence: 99%

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Laboratory Diagnosis of Infective Endocarditis

et al. 2017

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Infective endocarditis is life-threatening; identification of the underlying etiology informs optimized individual patient management. Changing epidemiology, advances in blood culture techniques, and new diagnostics guide the application of laboratory testing for diagnosis of endocarditis. Blood cultures remain the standard test for microbial diagnosis, with directed serological testing (i.e., Q fever serology, Bartonella serology) in culture-negative cases. Histopathology and molecular diagnostics (e.g., 16S rRNA gene PCR/sequencing, Tropheryma whipplei PCR) may be applied to resected valves to aid in diagnosis. Herein, we summarize recent knowledge in this area and propose a microbiologic and pathological algorithm for endocarditis diagnosis. KEYWORDS clinical microbiology, endocarditisD espite recent advances in diagnostic and therapeutic strategies, the mortality of infective endocarditis remains high, with more than one-third of patients affected dying within a year following diagnosis (1, 2). Identification of the specific underlying microbial etiology is essential for optimal patient management; delays in microbial diagnosis may contribute to late initiation of effective antimicrobial therapy, influencing morbidity and mortality. The modified Duke criteria provide a basic scheme for diagnosis and definition of endocarditis and rely on detection of infecting microorganisms in addition to echocardiographic and clinical findings (1, 3). The finding of two (or more) blood cultures positive for a typical microorganism consistent with infective endocarditis is a major criterion for infective endocarditis as is positive Q fever serology (anti-phase I IgG titer of Ն1:800). Echocardiographic findings are also considered but are beyond the scope of the manuscript.The epidemiology of endocarditis, which has shifted in recent years, should guide diagnostic testing. Today, staphylococci and streptococci combined cause ϳ80% of cases. Staphylococcus aureus remains the dominant pathogen, associated with ϳ25% to ϳ30% of cases, while coagulase-negative staphylococci account for ϳ11% of cases (4, 5). Streptococci, primarily viridans group streptococci, cause ϳ30% of cases, with Streptococcus gallolyticus (a Streptococcus bovis group member) being involved in ϳ20% to ϳ50% of streptococcal cases (4, 5). Enterococci, especially Enterococcus faecalis, account for ϳ10% of cases (4, 5). Gram-negative bacilli account for ϳ5% of cases and include the HACEK group organisms (Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, and Kingella species) and, less commonly, non-HACEK Gramnegative bacilli, such as the Enterobacteriaceae and nonfermenting Gram-negative bacilli. Fungi are rare endocarditis causes, with Candida species being the most common. A number of uncultivable or challenging to cultivate organisms cause endocarditis, the most common of which are Coxiella burnetii, Bartonella species, and Tropheryma whipplei.Endocarditis most often involves the aortic or mitral valves, with tricuspid valve involvement accoun...

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Section: Diagnosis Of Culture-negative Endocarditismentioning

confidence: 99%

Section: Diagnosis Of Culture-negative Endocarditismentioning

confidence: 99%

Section: Diagnosis Of Culture-negative Endocarditismentioning

confidence: 99%

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Laboratory Diagnosis of Infective Endocarditis

et al. 2017

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“…The first case of B. henselae endocarditis was reported by Spach et al (1993), followed by a number of additional reports (reviewed in ref. Houpikian and Raoult 2005). Three previous cases of prosthetic cardiac valve-associated endocarditis have been reported (Lesprit et al 2003, Hoffman et al 2007, Vikram et al 2007), one of which described cure without valve replacement (Lesprit et al 2003).…”

Section: Discussionmentioning

confidence: 99%

Bartonella henselaeInfection of Prosthetic Aortic Valve Associated with Colitis

Karris

Litwin²,

Dong³

et al. 2011

Vector-Borne and Zoonotic Diseases

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The diagnosis of infective endocarditis can be difficult, particularly with atypical presentation and negative blood cultures. A 61-year-old man with a porcine aortic valve presented with fever, intermittent confusion, diarrhea, and fatigue. In the community clinic setting, a colonoscopy performed for anemia demonstrated colitis. Symptoms progressed for months; elicitation of a history of significant kitten exposure and the finding of an axillary lymph node prompted testing for Bartonella henselae antibodies. High titer antibodies by indirect immunofluorescence assay indicated chronic B. henselae infection. Surgical valve replacement followed by prolonged doxycycline and rifampin led to cure. This case illustrates the complexities of infective endocarditis and is the first description B. henselae endocarditis associated with colitis in an immunocompetent adult.

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“…Routine postvaccine serology is not recommended due to resultant longterm cell-mediated immunity and successful vaccine efficacy (Ackland et al, 1994;Marmion et al, 1990;Gefenaite et al, 2011). Moreover, most cases of Q fever endocarditis occur in patients with previous valvulopathies (Houpikian & Raoult, 2005), highlighting the importance of vaccination and increased vigilance in those with underlying valvular pathology. Endovascular infections of aneurysms and vascular grafts have also been reported and may be underappreciated (Maurin & Raoult, 1999).…”

Section: Discussionmentioning

confidence: 99%

Coxiella burnetii endocarditis after Q fever vaccination

Trubiano

Holmes

Williams

et al. 2012

Journal of Medical Microbiology

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Coxiella burnetii is the causative bacterium of Q fever, a vaccine-preventable infection. C. burnetii is an unusual cause of culture-negative endocarditis. Here, we present a case of Q fever native valve endocarditis that developed in a young man despite prior vaccination. Definitive diagnosis was difficult and required C. burnetii-specific PCR testing. Case reportA 29-year-old Australian man was admitted in April 2012 for elective aortic and mitral valve replacement for progressive severe aortic and mitral regurgitation with mild aortic root dilatation from Marfan's syndrome. His past medical history included a meticillin-susceptible Staphylococcus aureus-colonized chronic left leg ulcer requiring oral flucloxacillin 500 mg four-times daily, chronic fatigue syndrome and recent partial dental clearance. He denied intravenous drug use. He lived in a country town where he worked as a house painter.A St Jude mitral and aortic valve replacement was performed with preservation of the aortic root. An intraoperative diagnosis of native valve infective endocarditis was suspected due to the appearance of concurrent healed aortic and mitral valve vegetations. Interestingly, his preoperative transoesophageal echocardiogram was normal.Post-operatively, further history of occupational and environmental exposures relevant to endocarditis was obtained. Cat scratches, farm animal exposure, ingestion of unpasteurized milk and abattoir work raised the possibility of Bartonella spp., Brucella spp. and Coxiella burnetii (Q fever) as infectious aetiologies. Twelve years earlier (late March 2000), he commenced work at a local abattoir. At commencement of employment, he underwent a medical review and was screened for Q fever on 28 March 2000: baseline serology was negative (immunofluorescence phase II antibody ,10, complement fixation test against phase II antigen ,2.5), and a skin test using 0.5 ml purified killed suspension of C. burnetii was also negative. Documentation illustrates that he was subsequently vaccinated 7 days later with Q-Vax (CSL Biotherapies Q fever vaccine 0.5 ml containing 25 mg purified killed suspension of C. burnetii). He worked at the abattoir for 8 months. Approximately 9 months later, he reported to his local medical officer with unexplained loss of weight (30 kg) and fatigue. In the intervening years prior to cardiac surgery, he also reported intermittent drenching night sweats; however, C. burnetii serology was not performed nor did he receive any antibiotic treatment other than flucloxacillin for his leg ulcer.Physical examination was remarkable for marfanoid features and chronic venous insufficiency of his left leg without active infection. An orthopantomogram excluded an odontogenic source of infection. Blood cultures performed intraand post-operatively revealed Staphylococcus hominis in 1 of 12 bottles; this was judged to represent contamination, and other culture bottles remained negative with extended incubation to 21 days. There were polymorphonuclear leukocytes on aortic and mitral valve tissue, b...

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Blood Culture-Negative Endocarditis in a Reference Center

Cited by 403 publications

References 100 publications

Laboratory Diagnosis of Infective Endocarditis

Laboratory Diagnosis of Infective Endocarditis

Bartonella henselaeInfection of Prosthetic Aortic Valve Associated with Colitis

Coxiella burnetii endocarditis after Q fever vaccination

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