Culture Negative Endocarditis: Advances in Diagnosis and Treatment

Abstract

Culture-negative endocarditis (CNE) is a challenging clinical entity, both diagnostically and therapeutically. In this chapter, the changed epidemiology and microbiology of CNE are reviewed with cases highlighting typical pathogens in patients pre-treated with antibiotics, less common fastidious pathogens such as bacteria of the H"CEK group, nutritionally deicient bacteria, Legionella spp. and Mycobacteria, quintessential CNE pathogens such as Bartonella spp., Coxiella burneti and Tropheryma whipplei, as well as fungal CNE. Contemporary diagnostic methods are reviewed including polymerase chain reaction-based pathogen s RN" ampliication coupled with electrospray ionization mass spectrometry (PCR/ESI-MS). Finally, treatment options per the recently updated "merican Heart "ssociation and European Society for Cardiology guideline are presented.

Possible Isolated Pulmonic Valve Endocarditis in a Patient With Sickle Cell Disease: A Case Report

“…In our case, we can consider the diagnosis of culture-negative bacterial endocarditis (CNBE). Skalweit et al 2016 consider CNBE “one of the most challenging infectious diseases clinical syndromes both diagnostically and therapeutically” [ 16 ]. Definitive diagnosis needs a biopsy and treatment includes antibiotics and cardiac surgery.…”

Clinical Profile and the Management of Mycotic Superior Mesenteric Artery (SMA) Aneurysm in Infective Endocarditis: A Potential Tsunami

“…Double valve endocarditis is uncommon, especially in patient without the history of RHD, vascular cannulation, intravenous (I.V) drug abuse or immune-compromised state. It has been attributed to regurgitant jets from the infected aortic valve striking the anterior mitral leaflet or due to contiguous spread of infection along the aortomitral curtain [2].…”

“…Chlamydia and Coxiella or fungi), in which prolonged incubation or different techniques are necessary. (c) True blood culture-negative endocarditis, due to intra-cellular bacteria that cannot be routinely cultured in blood with current techniques [2].…”

“…Surgical replacement for native valve endocarditis is indicated in patient with severe valvular dysfunction, thromboembolism or sepsis. These patients benefit from early surgical intervention [2]. The type of prosthetic valve to be used in infective endocarditis (mechanical or bioprosthesis) is controversial.…”