TABLE 3.
Agents of blood culture-negative endocarditis
| Bacterium | Clinical presentation | Method of Diagnosis | Underlying disease or condition | Nosocomial infection | No. of cases | Reference(s) |
|---|---|---|---|---|---|---|
| Coxiella burnetii | Fever (68%); cardiac failure (67%); hepatomegaly (56%); splenomegaly (55%); exposure to risk factors (61%); negative blood culture; echocardiography not contributory | IFA: IgG phase 1 titer, >1/800; cultivation of blood and resected valve in tissue culture; PCR of the resected valve | Prosthetic valve; previous valve injury; rheumatic heart disease; immunocompromise (cancer, HIV, corticosteroid therapy, organ transplantation, renal dialysis) | No | 359 | 29, 71, 207, 227, 228, 266, 280, 283 |
| Mycoplasma spp. | Fever; prosthetic valve dysfunction; congestive heart failure; negative blood culture; no vegetations on echocardiography | Cultivation of a portion of the annulus of the resected valve and serologic testing | Lupus erythematosus; prednisone; prosthetic valve; rheumatic fever | Yes (1 patient) | 2 | 45, 217 |
| Bartonella henselae | Fever; cardiac murmur; acute cardiac failure; vegetation on echocardiography; cat owner | Serology: IFA | Previous valve injury | No | 8 | 10, 63, 112, 126, 225 |
| Bartonella spp. (not determined) | Fever; cardiac murmur; acute cardiac failure; vegetation on echocardiography | Blood culture | No | 20 | 75, 172, 225; unpublished data | |
| Bartonella quintana | Fever; cardiac murmur; acute cardiac failure; vegetation on echocardiography; body louse | Culture and PCR; sequence analysis of the resected valve | Alcoholism; homelessness | No | 20 | 30, 65, 131, 168, 225, 257, 258 |
| Bartonella vinsonii | No fever | Histologic testing with Warthin-Starry stain and immunoperoxidase | No | 1 | 239 | |
| Bartonella elisabethae | Fever; cardiac murmur; vegetation on echocardiography | Histologic testing with Warthin-Starry stain and immunoperoxidase | No | 1 | 51 | |
| Mycobacteria other than M. tuberculosis | Fever; acute cardiac failure | Blood culture; presence of acid-fast bacilli on valves; culture of valves | Late prosthetic valve infection; contaminated prosthesis, water or environment | Yes | 15 | 6, 43, 146, 149, 159, 160, 241, 254, 288; Butany, Letter |
| Mycobacterium tuberculosis | Fever; acute cardiac failure | Necropsy; presence of acid-fast bacilli on valves; culture of valves | Miliary tuberculosis; congenital heart defects | No | 16 | 47 |
| Chlamydia spp. | Fever; cardiac murmur | Serologic testing; culture of blood and throat swab; immunohistochemistry and monoclonal antibody | Pneumonia | No | 28 | 18, 24, 60, 61, 89, 132, 136, 156, 231, 253, 285, 291, 295; Dumont et al., Letter; Norton et al., Letter |
| Legionella spp. | Fever; mild congestive heart failure; vegetation on echocardiography | Serologic testing; valve cultures; blood culture | Valve prosthesis; surgery; rheumatic fever | Yes | 9 | 182, 208, 281 |
| Whipple's disease bacillus | Fever; diarrhea; acute cardiac failure; cardiac murmur; vegetation on echocardiography | PCR and sequence analysis from paraffin-embedded valve | Not known | Not known | Probably not rare | 84, 181, 297; Jeserich et al., Letter |