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Clinical Microbiology Reviews, January 2001, p. 177-207, Vol. 14, No. 1
0893-8512/01/$04.00+0   DOI: 10.1128/CMR.14.1.177-207.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.

Endocarditis Due to Rare and Fastidious Bacteria

P. Brouqui* and D. Raoult

Unité des Rickettsies, CNRS UPRESA 6020, Faculté de Médecine, 13385 Marseille Cedex 5, France

The etiologic diagnosis of infective endocarditis is easily made in the presence of continuous bacteremia with gram-positive cocci. However, the blood culture may contain a bacterium rarely associated with endocarditis, such as Lactobacillus spp., Klebsiella spp., or nontoxigenic Corynebacterium, Salmonella, Gemella, Campylobacter, Aeromonas, Yersinia, Nocardia, Pasteurella, Listeria, or Erysipelothrix spp., that requires further investigation to establish the relationship with endocarditis, or the blood culture may be uninformative despite a supportive clinical evaluation. In the latter case, the etiologic agents are either fastidious extracellular or intracellular bacteria. Fastidious extracellular bacteria such as Abiotrophia, HACEK group bacteria, Clostridium, Brucella, Legionella, Mycobacterium, and Bartonella spp. need supplemented media, prolonged incubation time, and special culture conditions. Intracellular bacteria such as Coxiella burnetii cannot be isolated routinely. The two most prevalent etiologic agents of culture-negative endocarditis are C. burnetti and Bartonella spp. Their diagnosis is usually carried out serologically. A systemic pathologic examination of excised heart valves including periodic acid-Schiff (PAS) staining and molecular methods has allowed the identification of Whipple's bacillus endocarditis. Pathologic examination of the valve using special staining, such as Warthin-Starry, Gimenez, and PAS, and broad-spectrum PCR should be performed systematically when no etiologic diagnosis is evident through routine laboratory evaluation.

* Corresponding author. Mailing address: Unité des Rickettsies, CNRS UPRESA 6020, Faculté de Médecine, 27 Blvd. Jean Moulin, 13385 Marseille Cedex, France. Phone: 33 491 32 43 76. Fax: 33 491 83 03 90. E-mail: Philippe.Brouqui{at}medecine.univ-mrs.fr.

Clinical Microbiology Reviews, January 2001, p. 177-207, Vol. 14, No. 1
0893-8512/01/$04.00+0   DOI: 10.1128/CMR.14.1.177-207.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.


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