title: Diagnostic methods current best practices and guidelines for identification of difficult-to-culture pathogens in infective endocarditis.
abstract: Culture-negative endocarditis currently represents a diagnostic challenge for physicians. Traditional methods such as histology, serology, and culture have been improved and new molecular techniques have been developed to improve the detection of difficult-to-culture agents. Serologic tests for the two most frequent etiologic agents, Coxiella burnetii and Bartonella spp, should be performed first because they can usually be identified easily in this way. The sensitivity of culture for intracellular bacteria has been improved by inoculation of samples in shell vials and by the use of novel tissue cell lines. Recently, universal and species-specific primers have been designated to amplify bacterial DNA directly from resected valves, allowing positive identification.
authors.affiliation: Unité des Rickettsies, CNRS-UPRES-A 6020 Faculté de Médecine de Marseille, 27 Boulevard Jean Moulin, 13385 Marseille, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Houpikian
authors.forename: Didier
authors.initials: D
authors.lastname: Raoult
mesh_terms: D001419:Bacteria / Q000302:isolation & purification*; D001424:Bacterial Infections / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology; D003470:Culture Media; D004696:Endocarditis / Q000175:diagnosis* / Q000382:microbiology; D004697:Endocarditis, Bacterial / Q000175:diagnosis*; D005658:Fungi / Q000254:growth & development / Q000302:isolation & purification*; D006651:Histocytochemistry / Q000379:methods / Q000592:standards; D006801:Humans; D008828:Microbiological Techniques / Q000379:methods*; D008854:Microscopy, Electron; D025202:Molecular Diagnostic Techniques / Q000379:methods; D009181:Mycoses / Q000175:diagnosis; D016133:Polymerase Chain Reaction / Q000379:methods; D012698:Serologic Tests / Q000379:methods
chemical_list: D003470:Culture Media