title: Laboratory Approach to the Diagnosis of Culture-Negative Infective Endocarditis.
abstract: Blood-culture negative endocarditis (BCNE) accounts for up to 35% of all cases of infective endocarditis (IE) and is a serious life-threatening condition with considerable morbidity and mortality. Rapid detection and identification of the causative pathogen is essential for timely, directed therapy. Blood-culture negative endocarditis presents a diagnostic and therapeutic challenge. Causes of BCNE are varied including: treatment with antibiotic agents prior to blood culture collection; sub-optimal specimen collection; and/or infection due to fastidious (eg. nutritionally variant streptococci), intracellular (eg. Coxiella burnetii, Bartonella species) or non-culturable or difficult to culture organisms (eg. Mycobacteria, Tropheryma whipplei and fungi); as well as non-infective aetiologies. Here, we review aetiological and diagnostic approaches to BCNE including newer molecular based techniques, with a brief summary of imaging investigation and treatment principles.
authors.affiliation: Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology Medical Research, Westmead Hospital, Sydney, NSW, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Subedi
authors.affiliation: Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology Medical Research, Westmead Hospital, Sydney, NSW, Australia.
authors.forename: Z
authors.initials: Z
authors.lastname: Jennings
authors.affiliation: Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology Medical Research, Westmead Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Centre for Infectious Diseases and Microbiology, Westmead Hospital and the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW, Australia. Electronic address: sharon.chen@health.nsw.gov.au.
authors.forename: S C-A
authors.initials: SC
authors.lastname: Chen
mesh_terms: D001419:Bacteria / Q000254:growth & development / Q000302:isolation & purification; D015373:Bacterial Typing Techniques / Q000379:methods*; D004696:Endocarditis / Q000175:diagnosis* / Q000382:microbiology*; D006801:Humans; D008826:Microbial Sensitivity Tests / Q000379:methods
keywords: Blood culture negative endocarditis; Device associated infections; Endocarditis; Infective endocarditis; Nucleic acid amplification tests; Q fever