St. Luke's Hospital
Main Number: 314-434-1500 Emergency Dept: 314-205-6990 Patient Billing: 888-924-9200
Find a Physician Payment Options Locations & Directions
Follow us on: facebook twitter Mobile Email Page Email Page Print Page Print Page Increase Font Size Decrease Font Size Font Size
America's 50 Best Hospitals
Meet the Doctor
Spirit of Women
Community Health Needs Assessment
Home > Health Information

Multimedia Encyclopedia

    Print-Friendly
    Bookmarks

    Culture-negative endocarditis

    Endocarditis (culture-negative)

    Culture-negative endocarditis is an infection and inflammation of the lining of one or more heart valves in which no endocarditis-causing germs can be identified on a blood culture. The reason for this is that certain germs just do not grow well in the laboratory setting, or because some patients have previously received antibiotics that keep such germs from growing.

    See also:

    • Endocarditis
    • Infectious endocarditis

    Causes

    Endocarditis is usually a result of a blood infection. Bacteria can enter the bloodstream during certain medical procedures, including dental procedures, and travel to the heart, where it can settle on damaged heart valves.

    Existing heart disease and problems with your heart valves make you more likely to develop endocarditis. Risk factors include:

    • Artificial heart valves
    • Congenital heart disease (atrial septal defect, patent ductus arteriosus, and others)
    • Heart valve problems (such as mitral insufficiency)
    • History of rheumatic heart disease or previous endocarditis

    Intravenous drug users are also at risk for this condition, because dirty needles can cause bacteria to enter the bloodstream.

    However, an organism commonly found in the mouth, Streptococcus viridans, can cause endocarditis. This is why dental procedures increase your chances for developing this condition. Such procedures are especially risky for children with congenital heart conditions. As a result, it is common practice for children with some forms of congenital heart disease and adults with certain heart valve conditions to take antibiotics before any dental work.

    An estimated 10,000 to 15,000 new cases of endocarditis are diagnosed each year in the United States.

    Symptoms

    Symptoms of endocarditis may develop slowly (subacute) or suddenly (acute). Fever is the classic symptom and may persist for days before any other symptoms appear.

    Other symptoms may include extreme fatigue and breathing difficulty.

    Exams and Tests

    There is usually an obvious source of infection, such as an infected catheter, a dental abscess, or an infected skin lesion. However, in many patients there is no history of infection.

    A physical exam may reveal:

    • Heart murmur
    • Tachycardia (fast heart rate)

    The following tests may be done:

    • Chest x-ray
    • Complete blood count
    • Echocardiogram (ultrasound of the heart)
    • EKG
    • Transesophageal echocardiogram (TEE), a special echocardiogram done by introducing a small probe into the patient's mouth and down the esophagus

    Treatment

    You will be admitted to the hospital so you can receive medicines through a vein. Long-term, high-dose antibiotic or antifungal treatment is needed. Treatment is usually given for 4 - 6 weeks.

    Surgery may be needed to replace damaged heart valves.

    Outlook (Prognosis)

    Heart valves may be damaged if diagnosis and treatment are delayed.

    Possible Complications

    • Abnormal connections within the heart
    • Blood clots that travel to brain, kidneys, lungs, or abdomen
    • Brain abscess
    • Congestive heart failure
    • Rapid or irregular heartbeats, including atrial fibrillation
    • Severe valve damage
    • Stroke

    Prevention

    The American Heart Association recommends preventive antibiotics for people at risk for infectious endocarditis before:

    • Certain dental procedures
    • Surgeries on respiratory tract or infected skin, skin structures, or musculoskeletal tissue

    Antibiotics are more likely to be recommended those with the following risk factors:

    • Artificial heart valves
    • Certain congenital heart defects, both before or possibly after repair
    • History of infective endocarditis
    • Valve problems after a heart transplant

    Continued medical follow-up is recommended for people with a previous history of infectious endocarditis.

    Persons who use intravenous drugs should seek treatment for addiction. If this is not possible, use a new needle for each injection, avoid sharing any injection-related paraphernalia, and use alcohol pads before injecting to reduce risk.

    References

    Fowler VG Jr, Scheld WM, Bayer AS. Endocarditis and Intravascular Infections. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009; chapt 77.

    Karchmer AW. Infective Endocarditis. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. St. Louis, Mo: WB Saunders; 2007:chap 63.

    Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. 2007 Oct 9;116(15):1736-54.

    BACK TO TOP

    • Culture-negative endocar...

      illustration

      • Culture-negative endocar...

        illustration

      A Closer Look

        Self Care

          Tests for Culture-negative endocarditis

            Review Date: 4/27/2010

            Reviewed By: Daniel Levy, MD, Infectious Disease, Maryland Family Care, Lutherville, MD. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

            The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
            adam.com

            A.D.A.M. content is best viewed in IE9 or above, Fire Fox and chrome browser.


            Back  |  Top
            About Us
            Contact Us
            History
            Mission
            Locations & Directions
            Quality Reports
            Annual Reports
            Honors & Awards
            Community Health Needs
            Assessment

            Newsroom
            Services
            Brain & Spine
            Cancer
            Heart
            Maternity
            Orthopedics
            Pulmonary
            Sleep Medicine
            Urgent Care
            Women's Services
            All Services
            Patients & Visitors
            Locations & Directions
            Find a Physician
            Tour St. Luke's
            Patient & Visitor Information
            Contact Us
            Payment Options
            Financial Assistance
            Send a Card
            Mammogram Appointments
            Health Tools
            My Personal Health
            mystlukes
            Spirit of Women
            Health Information & Tools
            Clinical Trials
            Health Risk Assessments
            Employer Programs -
            Passport to Wellness

            Classes & Events
            Classes & Events
            Spirit of Women
            Donate & Volunteer
            Giving Opportunities
            Volunteer
            Physicians & Employees
            For Physicians
            Remote Access
            Medical Residency Information
            Pharmacy Residency Information
            Physician CPOE Training
            Careers
            Careers
            St. Luke's Hospital - 232 South Woods Mill Road - Chesterfield, MO 63017 Main Number: 314-434-1500 Emergency Dept: 314-205-6990 Patient Billing: 888-924-9200
            Copyright © St. Luke's Hospital Website Terms and Conditions  |  Privacy Policy  |  Patient Notice of Privacy Policies PDF Sitemap St. Luke's Mobile