Culture negative bacterial endocarditis confirming the diagnosis

Culture negative infective endocarditis

Twenty cases of culture negative infective endocarditis admitted to the Cardiology Department of Green Lane Hospital from 1959 to 1980 out of a total of 265 cases (7.5%), were analysed retrospectively. Cases were included only when adequate proof of endocarditis was available at surgery or postmortem. Indiscriminate use of antibiotics before taking blood cultures was the most common association with failure to obtain positive cultures, seen in 16 of the 20 patients described. Failure to obtain positive cultures in four cases was attributed to inadequate bacteriologic techniques before 1967. Where no antibiotics were given prior to collecting blood cultures and bacteriologic techniques were adequate, proven culture negative endocarditis was virtually unknown. When antibiotics have been given, repeated blood cultures are recommended following withdrawal of antibiotic for at least four days.

Echocardiographic detection of subvalvar aortic root aneurysm extending to mitral valve annulus as complication of aortic valve endocarditis

Acute aortic regurgitation as a consequence of infective endocarditis developed in a young man after peritonitis. A large subvalvar aortic root aneurysm extending to the mitral valve annulus together with features of severe acute aortic regurgitation were shown by M-mode echocardiography. The echocardiographic findings were confirmed at operation when obliteration of the aneurysmal space and aortic valve replacement were performed. Postoperative echocardiography confirmed obliteration of the aneurysmal space.

Fc rosette inhibition by serum of patients with infective endocarditis

The inhibition of lymphocyte Fc rosette formation was studied in sera of patients with infective endocarditis. The pretreatment value of sensitised chicken erythrocyte (EA) rosette inhibition was 37.9 +/- 7.8%; in controls it was 4.1 +/- 1.3% (P less than 0.001). The posttreatment value was 2.8 +/- 2.1%. Six patients had culture-negative infective endocarditis, and in them the value of EA rosette inhibition was higher than in the others (42.3 +/- 7.1%). The measurement of circulating immune complexes may be a diagnostic tool in patients with culture-negative infective endocarditis.

Fever of unknown origin in the elderly

An extensive literature survey was performed and hospital records were reviewed in order to identify cases of fever of undetermined origin in patients aged 65 or older. Analysis of the 111 cases discovered demonstrates a characteristic but not unique spectrum of underlying disorders. Potentially curable entities such as abdominal abscess, bacterial endocarditis, tuberculosis and giant-cell arteritis account for more than half of the serious illnesses presenting with prolonged pyrexia in elderly subjects. A diagnostic approach to the management of the persistently febrile geriatric patient is discussed.