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Epidemiologic considerations for endocarditis are complex as there can be infective and noninfective causes. Once a patient is hospitalized for endocarditis, the mortality rate is estimated to be 10%.[sup.1] This [...]

Background: Neurologic complications of endocarditis can influence diagnosis, therapeutic plans, and prognosis. Objective: To describe how early cerebral magnetic resonance imaging (MRI) affects the diagnosis and management of endocarditis in hospitalized adults. Design: Single-center prospective study between June 2005 and October 2008. (ClinicalTrials.gov registration number: NCT00144885) Setting: Tertiary care university hospital in France. Patients: 130 patients with endocarditis. Intervention: Cerebral MRI with angiography performed up to 7 days after admission and before any surgical intervention. Measurements: 2 experts jointly established the endocarditis diagnostic classification (according to Duke-modified criteria) and therapeutic plans just before and after MRI and then compared them. Results: Endocarditis was initially classified as definite in 77 patients and possible in 50 and was excluded in 3. Sixteen patients (12%) had acute neurologic symptoms. Cerebral lesions were detected by MRI in 106 patients (82% [95% CI, 75% to 89%]), including ischemic lesions in 68, microhemorrhages in 74, and silent aneurysms in 10. Solely on the basis of MRI results and excluding microhemorrhages, diagnostic classification of 17 of 53 (32%) cases of nondefinite endocarditis was upgraded to either definite (14 patients) or possible (3 patients). Endocarditis therapeutic plans were modified for 24 (18%) of the 130 patients, including surgical plan modifications for 18 (14%). Overall, early MRI led to modifications of diagnosis or therapeutic plan in 36 patients (28% [CI, 20% to 36%]). Limitation: Investigators did not assess whether the MRI-related changes in diagnosis and therapeutic plans improved patient outcomes or led to unnecessary procedures and increased costs. Conclusion: Cerebral lesions were identified by MRI in many patients with endocarditis but no neurologic symptoms. The MRI findings affected both diagnostic classifications and clinical management plans. Primary Funding Source: French Ministry of Health.

Background: Many cardiac and infectious diseases have a seasonal incidence. It is not known whether similar variations exist for endocarditis. Methods: As echocardiography plays a key role in diagnosing endocarditis, [...]

Objective: To assess the clinical validity of polymerase chain reaction (PCR) based molecular methods in the microbiological diagnosis of culture negative infective endocarditis in a group of surgically treated patients. [...]

Background: Bartonella special are emerging pathogens that are seldom reported as a cause of blood culture-negative endocarditis. Objective: To report the occurrence of, risk factors for, and clinical features of Bartonella endocarditis and to evaluate the diagnostic tools available for this condition. Design: Case series and comparison with past series. Setting: Multicenter international study in Halifax, Nova Scotia, Canada; Lyon, France; and Marseille, France. Patients: 22 patients from France, England, Canada, and South Africa were investigated for blood culture-negative endocarditis. Measurements: Titer of antibodies to Bartonella species by microimmunofluorescence assay, blood or vegetation culture, and amplification of Bartonella DNA from valvular tissue by polymerase chain reaction. Cross-adsorption was done for patients with antibodies to Chlamydia species. Results: 22 patients had definite endocarditis. Five were infected with B. quintana, 4 with B. henselae, and 13 with an undetermined Bartonella species. These cases were compared with the 11 previously reported cases. Of the patients with the newly reported cases, 19 had valvular surgery and 6 died. Nine were homeless, 11 were alcoholic, 4 owned cats, and 13 had preexisting valvular heart disease. Bartonella species caused 3% of the cases of endocarditis seen in the three study centers. The patients with these cases could have previously received a diagnosis of chlamydial endocarditis because of apparently high levels of cross-reacting antibodies to Chlamydia species. Conclusions: Bartonella species are an important cause of blood culture-negative endocarditis and can be identified by culture, serologic studies, or molecular biology techniques. Alcoholism and homelessness without previous valvular heart disease are risk factors for B. quintana infection but not for infection with other Bartonella species., The Bartonella species of bacteria may be responsible for a significant number of infections of the heart and its valves. Researchers analyzed the blood of 22 patients from France, England, Canada, and South Africa with endocarditis, an infection of the inner layer of the heart. All 22 patients were diagnosed with endocarditis, with five infected with Bartonella quintana, four with B. henselae, and 13 with other Bartonella infections. Nineteen patients had heart valve surgery; six patients died. Risk factors included homelessness, alcoholism, and owning cats.

Echocardiography has become an important, noninvasive diagnostic tool in the evaluation of patients with cardiovascular disease. Technologic refinements in two-dimensional and Doppler imaging have allowed for precise, noninvasive diagnosis, particularly [...]

Endocarditis, or inflammation of the lining membrane of the heart, is found among some patients whose blood is infected with the bacterium Staphylococcus aureus, and it is in these cases that the highest mortality from Staphylococcus aureus infection is seen. It has been difficult, however, to devise a blood test to distinguish those patients with endocarditis from those who simply have Staphylococcus aureus infection in their blood. It is known that capsular polysaccharides (CPs), which are a complex chain of sugars that form a protective layer over each bacterial cell, are present in S. aureus and that there are two major types: type 5 and type 8 CPs. Antibodies to these polysaccharide types have been discovered in the blood and are easily measured. Patients with endocarditis more often have measurable antibodies to CPs than those with uncomplicated Staphylococcus infection. In a study of the value of using the measured antibody levels to CP types 5 and 8 as an indication of the presence of endocarditis in patients infected with S. aureus, blood was collected from 33 infected patients and uninfected controls. Of the infected patients, 23 tested positive for antibodies to CP type 8, and five tested positive for antibodies to CP type 5. These results were significantly correlated with other diagnostic information confirming a diagnosis of endocarditis. It is therefore proposed that a blood test for antibodies to CPs types 8 and 5 is the first known to correctly diagnose patients with endocarditis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Culture-negative bacterial endocarditis may be attributed to fastidious microorganisms, prior institution of antibiotic treatment, or both. We describe a case of culture-negative endocarditis in which a modified Steiner stain revealed bacterial structures in the resected heart valve material. Prompted by this finding, broad-range polymerase chain reaction (PCR) amplification of small-subunit ribosomal DNA (16S rDNA) was performed, and Cardiobacterium hominis sequences were detected. This case demonstrates the usefulness of both the Steiner stain and broad-range direct molecular amplification as supplemental diagnostic tools in identification of otherwise unexplained infections. Arch Intern Med. 2002;162:477-479

A 40-year-old African-American man with a 20 pack-year history of smoking was admitted to the hospital with acute abdominal pain. Physical examination revealed bilateral upper quadrant abdominal pain associated with [...]

Transthoracic echocardiography was used to evaluate a suspected case of endocarditis related to a malfunctioning mitral prosthetic valve. The study was considered suboptimal for the evaluation of the aortic and mitral valves, and the patient was referred for transesophageal echocardiography, which showed a normally functioning prosthesis. It also brought to light the clinically unexpected finding of endocarditis on the aortic valve leaflets.

First described in the 1800s, nonbacterial thrombotic endocarditis (NBTE) was initially dismissed as clinically insignificant, a post-mortem diagnosis or complication seen in patients suffering from malignancies, hypercoagulable states or autoimmune disorders. While occasional studies and reports over the last several decades have proven it to be a major clinical problem with serious sequela, it remains underdiagnosed and underreported. We present the case of a 44 year-old male with recurrent transient ischemic attacks who developed NBTE status post surgical repair of a patent foramen ovale and mitral valvulopathy, illustrating a unique presentation and etiology that has rarely been mentioned or described in medical literature. Keywords: nonbacterial thrombotic endocarditis | mitral valve repair | patent foramen ovale | surgical complication | marantic | stroke | anticoagulation, Case presentation Patient X was a 44 year-old male with a past medical history of mitral valve regurgitation and patent foramen ovale status post surgical correction of both conditions two [...]

Blood Culture-negative Endocarditis: What Can the Laboratory Bring to the Table? Abstract & Commentary By Ellen Jo Baron, Ph.D., D(ABMM), Professor Emerita, Stanford University School of Medicine, Director of Medical [...]

Nonbacterial thrombotic endocarditis (NBTE) is difficult to detect antemortem and is often not suspected until embolic events occur. Transthoracic echocardiography is useful in diagnosing NBTE, but it may be limited [...]

Endocarditis is a rare and the most fatal complication of brucellosis and can cause severe cardiac injuries.Generally aortic valve invasion is seen. We describe a case of Complicated brucella endocarditis of the aortic valve. Keywords: Brucellosis | endocarditis.vegetation | leaflet perforation., Introduction Brucellosis shows various clinical signs and can affect different organs.Although rare, endocarditis is important due to its fatality potential (1). Brucella endocarditis had been first reported in 1906, but [...]