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Comprehensive diagnostic strategy for blood culture-negative endocarditis: a prospective study of 819 new cases.
Clin Infect Dis. 2010 Jul 15; 51(2):131-40.CI

Abstract

BACKGROUND

. Blood culture-negative endocarditis (BCNE) may account for up to 31% of all cases of endocarditis.

METHODS.

We used a prospective, multimodal strategy incorporating serological, molecular, and histopathological assays to investigate specimens from 819 patients suspected of having BCNE.

RESULTS.

Diagnosis of endocarditis was first ruled out for 60 patients. Among 759 patients with BCNE, a causative microorganism was identified in 62.7%, and a noninfective etiology in 2.5%. Blood was the most useful specimen, providing a diagnosis for 47.7% of patients by serological analysis (mainly Q fever and Bartonella infections). Broad-range polymerase chain reaction (PCR) of blood and Bartonella-specific Western blot methods diagnosed 7 additional cases. PCR of valvular biopsies identified 109 more etiologies, mostly streptococci, Tropheryma whipplei, Bartonella species, and fungi. Primer extension enrichment reaction and autoimmunohistochemistry identified a microorganism in 5 additional patients. No virus or Chlamydia species were detected. A noninfective cause of endocarditis, particularly neoplasic or autoimmune disease, was determined by histological analysis or by searching for antinuclear antibodies in 19 (2.5%) of the patients. Our diagnostic strategy proved useful and sensitive for BCNE workup.

CONCLUSIONS.

We highlight the major role of zoonotic agents and the underestimated role of noninfective diseases in BCNE. We propose serological analysis for Coxiella burnetii and Bartonella species, detection of antinuclear antibodies and rheumatoid factor as first-line tests, followed by specific PCR assays for T. whipplei, Bartonella species, and fungi in blood. Broad-spectrum 16S and 18S ribosomal RNA PCR may be performed on valvular biopsies, when available.

Authors+Show Affiliations

Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Centre National de la Recherche Scientifique-Institut de Recherche pour le Développement, Unité Mixte de Recherche 6236, Faculté de Médecine, Université de la Méditerranée, France.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20540619

Citation

Fournier, Pierre-Edouard, et al. "Comprehensive Diagnostic Strategy for Blood Culture-negative Endocarditis: a Prospective Study of 819 New Cases." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 51, no. 2, 2010, pp. 131-40.
Fournier PE, Thuny F, Richet H, et al. Comprehensive diagnostic strategy for blood culture-negative endocarditis: a prospective study of 819 new cases. Clin Infect Dis. 2010;51(2):131-40.
Fournier, P. E., Thuny, F., Richet, H., Lepidi, H., Casalta, J. P., Arzouni, J. P., Maurin, M., Célard, M., Mainardi, J. L., Caus, T., Collart, F., Habib, G., & Raoult, D. (2010). Comprehensive diagnostic strategy for blood culture-negative endocarditis: a prospective study of 819 new cases. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 51(2), 131-40. https://doi.org/10.1086/653675
Fournier PE, et al. Comprehensive Diagnostic Strategy for Blood Culture-negative Endocarditis: a Prospective Study of 819 New Cases. Clin Infect Dis. 2010 Jul 15;51(2):131-40. PubMed PMID: 20540619.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comprehensive diagnostic strategy for blood culture-negative endocarditis: a prospective study of 819 new cases. AU - Fournier,Pierre-Edouard, AU - Thuny,Franck, AU - Richet,Hervé, AU - Lepidi,Hubert, AU - Casalta,Jean-Paul, AU - Arzouni,Jean-Pierre, AU - Maurin,Max, AU - Célard,Marie, AU - Mainardi,Jean-Luc, AU - Caus,Thierry, AU - Collart,Frédéric, AU - Habib,Gilbert, AU - Raoult,Didier, PY - 2010/6/15/entrez PY - 2010/6/15/pubmed PY - 2010/9/21/medline SP - 131 EP - 40 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin Infect Dis VL - 51 IS - 2 N2 - BACKGROUND. Blood culture-negative endocarditis (BCNE) may account for up to 31% of all cases of endocarditis. METHODS. We used a prospective, multimodal strategy incorporating serological, molecular, and histopathological assays to investigate specimens from 819 patients suspected of having BCNE. RESULTS. Diagnosis of endocarditis was first ruled out for 60 patients. Among 759 patients with BCNE, a causative microorganism was identified in 62.7%, and a noninfective etiology in 2.5%. Blood was the most useful specimen, providing a diagnosis for 47.7% of patients by serological analysis (mainly Q fever and Bartonella infections). Broad-range polymerase chain reaction (PCR) of blood and Bartonella-specific Western blot methods diagnosed 7 additional cases. PCR of valvular biopsies identified 109 more etiologies, mostly streptococci, Tropheryma whipplei, Bartonella species, and fungi. Primer extension enrichment reaction and autoimmunohistochemistry identified a microorganism in 5 additional patients. No virus or Chlamydia species were detected. A noninfective cause of endocarditis, particularly neoplasic or autoimmune disease, was determined by histological analysis or by searching for antinuclear antibodies in 19 (2.5%) of the patients. Our diagnostic strategy proved useful and sensitive for BCNE workup. CONCLUSIONS. We highlight the major role of zoonotic agents and the underestimated role of noninfective diseases in BCNE. We propose serological analysis for Coxiella burnetii and Bartonella species, detection of antinuclear antibodies and rheumatoid factor as first-line tests, followed by specific PCR assays for T. whipplei, Bartonella species, and fungi in blood. Broad-spectrum 16S and 18S ribosomal RNA PCR may be performed on valvular biopsies, when available. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/20540619/full_citation L2 - https://academic.oup.com/cid/article-lookup/doi/10.1086/653675 DB - PRIME DP - Unbound Medicine ER -