Endocarditis with negative blood cultures

Article Abstract:

Patients with endocarditis (bacterial infection of the heart) are usually diagnosed by a positive blood culture, or growth of bacteria from a blood sample. Between 2.5% and 31% of endocarditis patients have negative blood cultures, however. Treatment with antibiotics may cause a negative blood culture, for example. Removal of antibiotics from a blood sample may result in a positive blood culture. Some types of bacteria that cause endocarditis may be difficult to grow from a blood sample, and their growth may require the use of special laboratory techniques. Blood cultures of patients with endocarditis caused by Coxiella burnetii, the bacterium that causes Q fever, are never positive. They must be diagnosed by high blood levels of antibodies against the bacterium. Individuals with endocarditis caused by Chlamydia may be diagnosed by a positive blood and throat culture in a combination with other tests. Endocarditis patients with a negative blood culture should be treated with penicillin or a combination of antibiotics. Patients who do not improve after treatment with antibiotics may have endocarditis caused by a fungus.

Editorial

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Brief report: Chlamydia psittaci endocarditis diagnosed by blood culture

Article Abstract:

Patients with endocarditis, or bacterial infection of the heart, who have negative blood cultures and have had recent exposure to a bird may have endocarditis caused by Chlamydia psittaci. Chlamydia psittaci, the bacterium that causes parrot fever in birds, can cause endocarditis in humans. A 31-year-old woman with fever, chills, joint and muscle pain and a cough visited her doctor. A chest X-ray revealed an enlarged heart, and she was admitted to the hospital. Multiple blood cultures were negative, but symptoms persisted despite treatment with antibiotics. She underwent surgery for heart valve replacement. She was treated with more antibiotics, but did not improve. An interview by infectious disease specialists revealed that she had been exposed to a parakeet several months earlier. Both a blood sample and a throat swab that were cultured for Chlamydia psittaci were positive. Analysis of heart valve tissue from the patient revealed antibodies against Chlamydia. She was treated with antibiotics specific for Chlamydia infections.

Case studies

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Community-acquired bacterial meningitis in adults

Article Abstract:

The concepts of the initial approach to the treatment of adults with bacterial meningitis are summarized, highlighting adjunctive dexamethasone therapy and focusing on the management of neurologic complications. The adults presenting with community-acquired acute bacterial meningitis show at least two of four symptoms like headache, fever, neck stiffness, and altered mental status.

England, Care and treatment, Usage, Dexamethasone, Bacterial meningitis

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