AI Article Synopsis
- * Despite multiple sterile blood cultures and no pathogens found in routine testing, molecular genetic testing using PCR successfully identified Tropheryma whipplei as the causative agent of the endocarditis.
- * The treatment plan included a 14-day course of intravenous ceftriaxone followed by a year of oral trimethoprim/sulfamethoxazole, highlighting the necessity of advanced diagnostic methods for accurate pathogen identification in cases where standard blood cultures fail.
Article Abstract
A 60-year-old male patient presented with ischemic-embolic stroke. Transesophageal echocardiography revealed the cause to be aortic valve endocarditis with highly eccentric aortic valve regurgitation. The blood cultures taken several times remained sterile. The indication for surgical aortic valve replacement was made. Conventional microbiological work-up of the heart valve did not reveal any pathogens. The additional molecular genetic testing using eubacterial PCR ("polymerase chain reaction" [PCR]) finally demonstrated the presence of Tropheryma whipplei. A number of therapeutic options were available. The authors decided on intravenous antibiotic therapy with ceftriaxone for 14 days and follow-up therapy with oral trimethoprim/sulfamethoxazole for 1 year. The case illustrates the importance of additional molecular diagnostics beyond the conventional methods in blood culture-negative endocarditis to identify the pathogen and initiate appropriate therapy.
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| http://dx.doi.org/10.1007/s00108-024-01685-4 | DOI Listing |
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