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Endocarditis due to rare and fastidious bacteria.

P Brouqui1, D Raoult

  • 1Unité des Rickettsies, CNRS UPRESA 6020, Faculté de Médecine, 13385 Marseille Cedex 5, France. Philippe.Brouqui@medecine.univ-mrs.fr

Clinical Microbiology Reviews
|January 9, 2001
PubMed
Summary

Diagnosing infective endocarditis can be challenging with rare bacteria or uninformative blood cultures. Advanced methods like serology and valve pathology are crucial for identifying difficult-to-culture agents.

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Area of Science:

  • Infectious Diseases
  • Microbiology
  • Cardiology

Background:

  • Infective endocarditis diagnosis is straightforward with typical gram-positive cocci bacteremia.
  • Uncommon bacteria or negative blood cultures complicate etiologic diagnosis.
  • Fastidious or intracellular bacteria are often implicated in culture-negative endocarditis.

Purpose of the Study:

  • To review diagnostic challenges in infective endocarditis.
  • To highlight methods for identifying rare and fastidious bacterial causes.
  • To emphasize the role of advanced pathological and molecular techniques.

Main Methods:

  • Review of literature on infective endocarditis diagnostics.
  • Discussion of culture-based and non-culture-based diagnostic approaches.
  • Emphasis on serological and histopathological examination of heart valves.

Main Results:

  • Rare bacteria (e.g., Lactobacillus, Klebsiella, HACEK group) can cause endocarditis.
  • Coxiella burnetii and Bartonella spp. are leading causes of culture-negative endocarditis, diagnosed serologically.
  • Pathological examination with special stains (PAS, Warthin-Starry) and PCR aids in identifying agents like Whipple's bacillus.

Conclusions:

  • Standard blood cultures are insufficient for diagnosing endocarditis caused by fastidious or intracellular bacteria.
  • Serological tests and thorough valve pathology are essential for definitive diagnosis in challenging cases.
  • Systematic pathological examination should be employed when routine cultures are uninformative.

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