Culture-negative endocarditis: Difference between revisions

Latest revision as of 17:01, 25 January 2022

Differential Diagnosis

Common Fastidious Organisms

Organism	Clinical clues	Diagnostic tests
Brucella	unpasteurized dairy	blood cultures, serology, culture, immunohistology, PCR
Coxiella burnetii	animal exposure (especially pregnant sheep)	serology (IgG phase I >1:800), tissue culture, immunohistology, PCR
Bartonella	cat exposure, louse exposure, crowding, homelessness	blood cultures, serology, culture, immunohistology, PCR
Tropheryma whipplei		histology and PCR
Mycoplasma		serology, culture, immunohistology, PCR
Legionella		blood cultures, serology, culture, immunohistology, PCR
Fungi	IV drug use, immunocompromise	blood cultures, serology, PCR

Organisms by Risk Factor

Homelessness with body lice: Bartonella quintana
Occupational exposures
- Butchers, fishermen, homemakers, veterinarians, farmers: Erysipelothrix rhusiopathiae
- Farmers, veterinarians: Coxiella burnetii, Brucella
Intravenous drug use:
- Right-sided with advanced HIV: Salmonella, Neisseria subflava
- Pharyngitis: Corynebacterium diphtheriae
- Other: Neisseria sicca, Clostridium, Candida
Open heart surgery: Legionella, non-tuberculous mycobacteria including Mycobacterium avium complex, Nocardia
Gastroenteritis: Salmonella
Sinusitis: Haemophilus influenzae
Pneumonitis: Chlamydia psittaci
Diarrhea: Tropheryma whipplei
Urinary tract infection: Klebsiella
Dental procedures: Kingella kingae, Cardiobacterium hominis, Actinobacillus actinomicetemcomitans, Haemophilus parainfluenzae, Lactobacillus speies
- Cirrhosis and alcoholism: Campylobacter fetus
- Immunocompromised patient: Gemella
- Intravenous drug use: Eikonella corrodens
- Urinary tract infection: Haemophilus
Sexually-transmitted infection: Neisseria gonorrhoeae
Medicinal leeches: Aeromonas hydrophila
Dog or cat exposure: Pasteurella, Bartonella henselae (cats)
Cattle exposure with prosthetic valve: Coxiella burnetii, Brucella
Pregnancy: Listeria monocytogenes
Cirrhosis or chronic alcohol use: Bartonella quintana, Erysipelothrix, Campylobacter, Aeromonas, Pasteurella, Listeria monocytogenes

Investigations

Blood cultures
- Routine, modern blood culture incubation will grow almost all easily-cultivable bacteria

@@ Line 1: / Line 1: @@
+== Differential Diagnosis ==
+=== Common Fastidious Organisms ===
 {| class="wikitable"
 !Organism
@@ Line 4: / Line 7: @@
 !Diagnostic tests
 |-
-|[[Brucella species]]
+|[[Brucella]]
 |unpasteurized dairy
 |blood cultures, serology, culture, immunohistology, PCR
@@ Line 12: / Line 15: @@
 |serology (IgG phase I >1:800), tissue culture, immunohistology, PCR
 |-
-|[[Bartonella species]]
+|[[Bartonella]]
-|cat exposure, louse exposure, crowding
+|cat exposure, louse exposure, crowding, homelessness
 |blood cultures, serology, culture, immunohistology, PCR
 |-
@@ Line 20: / Line 23: @@
 |histology and PCR
 |-
-|[[Mycoplasma species]]
+|[[Mycoplasma]]
 |
 |serology, culture, immunohistology, PCR
 |-
-|[[Legionella species]]
+|[[Legionella]]
 |
 |blood cultures, serology, culture, immunohistology, PCR
@@ Line 32: / Line 35: @@
 |blood cultures, serology, PCR
 |}
+=== Organisms by Risk Factor ===
+* Homelessness with body lice: [[Bartonella quintana]]
+* Occupational exposures
+** Butchers, fishermen, homemakers, veterinarians, farmers: [[Erysipelothrix rhusiopathiae]]
+** Farmers, veterinarians: [[Coxiella burnetii]], [[Brucella]]
+* Intravenous drug use:
+** Right-sided with advanced [[HIV]]: [[Salmonella]], [[Neisseria subflava]]
+** [[Pharyngitis]]: [[Corynebacterium diphtheriae]]
+** Other: [[Neisseria sicca]], [[Clostridium]], [[Candida]]
+* Open heart surgery: [[Legionella]], [[non-tuberculous mycobacteria]] including [[Mycobacterium avium complex]], [[Nocardia]]
+* Gastroenteritis: [[Salmonella]]
+* Sinusitis: [[Haemophilus influenzae]]
+* [[Pneumonitis]]: [[Chlamydia psittaci]]
+* [[Diarrhea]]: [[Tropheryma whipplei]]
+* [[Urinary tract infection]]: [[Klebsiella]]
+* Dental procedures: [[Kingella kingae]], [[Cardiobacterium hominis]], [[Actinobacillus actinomicetemcomitans]], [[Haemophilus parainfluenzae]], [[Lactobacillus speies]]
+** Cirrhosis and alcoholism: [[Campylobacter fetus]]
+** Immunocompromised patient: [[Gemella]]
+** Intravenous drug use: [[Eikonella corrodens]]
+** Urinary tract infection: [[Haemophilus]]
+* [[Sexually-transmitted infection]]: [[Neisseria gonorrhoeae]]
+* Medicinal leeches: [[Aeromonas hydrophila]]
+* Dog or cat exposure: [[Pasteurella]], [[Bartonella henselae]] (cats)
+* Cattle exposure with prosthetic valve: [[Coxiella burnetii]], [[Brucella]]
+* Pregnancy: [[Listeria monocytogenes]]
+* [[Cirrhosis]] or chronic alcohol use: [[Bartonella quintana]], [[Erysipelothrix]], [[Campylobacter]], [[Aeromonas]], [[Pasteurella]], [[Listeria monocytogenes]]
+== Investigations ==
+* Blood cultures
+** Routine, modern blood culture incubation will grow almost all easily-cultivable bacteria
 [[Category:Cardiac infections]]
 [[Category:Infectious diseases]]