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Laboratory Approach to the Diagnosis of Culture-Negative Infective Endocarditis
S Subedi1, Z Jennings1, S C-A Chen2
1Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology Medical Research, Westmead Hospital, Sydney, NSW, Australia.
Heart, Lung & Circulation
|April 5, 2017
Summary
Blood-culture negative endocarditis (BCNE) is a challenging diagnosis, often caused by difficult-to-culture pathogens. This review covers diagnostic and therapeutic strategies for BCNE, including modern molecular techniques.
Area of Science:
- Infectious Diseases
- Cardiology
- Microbiology
Background:
- Blood-culture negative endocarditis (BCNE) comprises up to 35% of infective endocarditis (IE) cases.
- BCNE poses significant diagnostic and therapeutic challenges due to various causative agents and pre-analytical factors.
- Prompt pathogen identification is crucial for effective, targeted treatment of BCNE.
Purpose of the Study:
- To review the diverse etiologies of BCNE.
- To outline current and emerging diagnostic approaches for BCNE.
- To summarize imaging and treatment principles for BCNE management.
Main Methods:
- Review of etiological factors contributing to BCNE.
- Discussion of diagnostic challenges and strategies, emphasizing molecular techniques.
- Brief overview of relevant imaging modalities and therapeutic guidelines.
Main Results:
- Identified causes of BCNE include prior antibiotic treatment, suboptimal cultures, and fastidious, intracellular, or non-culturable organisms.
- Molecular-based techniques offer promising advancements in pathogen detection for BCNE.
- A comprehensive approach integrating diagnostics, imaging, and tailored therapy is essential.
Conclusions:
- BCNE requires a multifaceted diagnostic and therapeutic strategy due to its complex etiology.
- Advanced molecular diagnostics are vital for improving the detection rates of causative agents in BCNE.
- Timely and accurate diagnosis is paramount to reduce morbidity and mortality associated with BCNE.