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 7: / Line 7: @@
 !Diagnostic tests
 |-
-|[[Brucella species]]
+|[[Brucella]]
 |unpasteurized dairy
 |blood cultures, serology, culture, immunohistology, PCR
@@ Line 15: / Line 15: @@
 |serology (IgG phase I >1:800), tissue culture, immunohistology, PCR
 |-
-|[[Bartonella species]]
+|[[Bartonella]]
 |cat exposure, louse exposure, crowding, homelessness
 |blood cultures, serology, culture, immunohistology, PCR
@@ Line 23: / Line 23: @@
 |histology and PCR
 |-
-|[[Mycoplasma species]]
+|[[Mycoplasma]]
 |
 |serology, culture, immunohistology, PCR
 |-
-|[[Legionella species]]
+|[[Legionella]]
 |
 |blood cultures, serology, culture, immunohistology, PCR
@@ Line 41: / Line 41: @@
 * Occupational exposures
 ** Butchers, fishermen, homemakers, veterinarians, farmers: [[Erysipelothrix rhusiopathiae]]
-** Farmers, veterinarians: [[Coxiella burnetii]], [[Brucella species]]
+** Farmers, veterinarians: [[Coxiella burnetii]], [[Brucella]]
 * Intravenous drug use:
-** Right-sided with advanced [[HIV]]: [[Salmonella species]], [[Neisseria subflava]]
+** Right-sided with advanced [[HIV]]: [[Salmonella]], [[Neisseria subflava]]
 ** [[Pharyngitis]]: [[Corynebacterium diphtheriae]]
-** Other: [[Neisseria sicca]], [[Clostridium species]], [[Candida species]]
+** Other: [[Neisseria sicca]], [[Clostridium]], [[Candida]]
-* Open heart surgery: [[Legionella species]], [[non-tuberculous mycobacteria]] including [[Mycobacterium avium complex]], [[Nocardia species]]
+* Open heart surgery: [[Legionella]], [[non-tuberculous mycobacteria]] including [[Mycobacterium avium complex]], [[Nocardia]]
-* Gastroenteritis: [[Salmonella species]]
+* Gastroenteritis: [[Salmonella]]
 * Sinusitis: [[Haemophilus influenzae]]
 * [[Pneumonitis]]: [[Chlamydia psittaci]]
 * [[Diarrhea]]: [[Tropheryma whipplei]]
-* [[Urinary tract infection]]: [[Klebsiella species]]
+* [[Urinary tract infection]]: [[Klebsiella]]
 * Dental procedures: [[Kingella kingae]], [[Cardiobacterium hominis]], [[Actinobacillus actinomicetemcomitans]], [[Haemophilus parainfluenzae]], [[Lactobacillus speies]]
 ** Cirrhosis and alcoholism: [[Campylobacter fetus]]
-** Immunocompromised patient: [[Gemella species]]
+** Immunocompromised patient: [[Gemella]]
 ** Intravenous drug use: [[Eikonella corrodens]]
-** Urinary tract infection: [[Haemophilus species]]
+** Urinary tract infection: [[Haemophilus]]
 * [[Sexually-transmitted infection]]: [[Neisseria gonorrhoeae]]
 * Medicinal leeches: [[Aeromonas hydrophila]]
-* Dog or cat exposure: [[Pasteurella species]], [[Bartonella henselae]] (cats)
+* Dog or cat exposure: [[Pasteurella]], [[Bartonella henselae]] (cats)
-* Cattle exposure with prosthetic valve: [[Coxiella burnetii]], [[Brucella species]]
+* Cattle exposure with prosthetic valve: [[Coxiella burnetii]], [[Brucella]]
 * Pregnancy: [[Listeria monocytogenes]]
-* [[Cirrhosis]] or chronic alcohol use: [[Bartonella quintana]], [[Erysipelothrix species]], [[Campylobacter species]], [[Aeromonas species]], [[Pasteurella species]], [[Listeria monocytogenes]]
+* [[Cirrhosis]] or chronic alcohol use: [[Bartonella quintana]], [[Erysipelothrix]], [[Campylobacter]], [[Aeromonas]], [[Pasteurella]], [[Listeria monocytogenes]]
 == Investigations ==