Document Detail


Comprehensive diagnostic strategy for blood culture-negative endocarditis: a prospective study of 819 new cases.
MedLine Citation:
PMID:  20540619     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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:
Pierre-Edouard Fournier; Franck Thuny; Hervé Richet; Hubert Lepidi; Jean-Paul Casalta; Jean-Pierre Arzouni; Max Maurin; Marie Célard; Jean-Luc Mainardi; Thierry Caus; Frédéric Collart; Gilbert Habib; Didier Raoult
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Clinical infectious diseases : an official publication of the Infectious Diseases Society of America     Volume:  51     ISSN:  1537-6591     ISO Abbreviation:  Clin. Infect. Dis.     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-06-21     Completed Date:  2010-09-20     Revised Date:  2011-02-03    
Medline Journal Info:
Nlm Unique ID:  9203213     Medline TA:  Clin Infect Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  131-40     Citation Subset:  IM    
Affiliation:
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.
Data Bank Information
Bank Name/Acc. No.:
GENBANK/EU139419;  EU139420;  EU139421;  EU139422
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Autoimmune Diseases / diagnosis,  pathology
Bacterial Infections / diagnosis,  microbiology
Child
Endocarditis / diagnosis*,  etiology*,  pathology
Female
Humans
Immunoassay / methods
Immunohistochemistry / methods
Male
Middle Aged
Molecular Diagnostic Techniques / methods
Molecular Sequence Data
Neoplasms / diagnosis,  pathology
Pathology, Molecular / methods
Polymerase Chain Reaction / methods
Prospective Studies
Young Adult
Comments/Corrections
Comment In:
Clin Infect Dis. 2010 Jul 15;51(2):141-2   [PMID:  20540618 ]
Rev Chilena Infectol. 2010 Dec;27(6):572-3

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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