Raoult D, Casalta J P, Richet H, Khan M, Bernit E, Rovery C, Branger S, Gouriet F, Imbert G, Bothello E, Collart F, Habib G
Unité des Rickettsies, Hôpital de la Timone, Faculté de Médicine, Université de la Méditerranée, 13385 Marseille cedex 05, France.
J Clin Microbiol. 2005 Oct;43(10):5238-42. doi: 10.1128/JCM.43.10.5238-5242.2005.
Despite progress with diagnostic criteria, the type and timing of laboratory tests used to diagnose infective endocarditis (IE) have not been standardized. This is especially true with serological testing. Patients with suspected IE were evaluated by a standard diagnostic protocol. This protocol mandated an evaluation of the patients according to the modified Duke criteria and used a battery of laboratory investigations, including three sets of blood cultures and systematic serological testing for Coxiella burnetii, Bartonella spp., Aspergillus spp., Legionella pneumophila, and rheumatoid factor. In addition, cardiac valvular materials obtained at surgery were subjected to a comprehensive diagnostic evaluation, including PCR aimed at documenting the presence of fastidious organisms. The study included 1,998 suspected cases of IE seen over a 9-year period from April 1994 to December 2004 in Marseilles, France. They were evaluated prospectively. A total of 427 (21.4%) patients were diagnosed as having definite endocarditis. Possible endocarditis was diagnosed in 261 (13%) cases. The etiologic diagnosis was established in 397 (93%) cases by blood cultures, serological tests, and examination of the materials obtained from cardiac valves, respectively, in 348 (81.5%), 34 (8%), and 15 (3.5%) definite cases of IE. Concomitant infection with streptococci and C. burnetii was seen in two cases. The results of serological and rheumatoid factor evaluation reclassified 38 (8.9%) possible cases of IE as definite cases. Systematic serological testing improved the performance of the modified Duke criteria and was instrumental in establishing the etiologic diagnosis in 8% (34/427) cases of IE.
尽管在诊断标准方面取得了进展，但用于诊断感染性心内膜炎（IE）的实验室检查类型和时机尚未标准化。血清学检测尤其如此。对疑似IE的患者采用标准诊断方案进行评估。该方案要求根据改良的杜克标准对患者进行评估，并进行一系列实验室检查，包括三组血培养以及针对伯氏考克斯体、巴尔通体属、曲霉属、嗜肺军团菌和类风湿因子的系统血清学检测。此外，对手术中获取的心脏瓣膜材料进行全面诊断评估，包括旨在检测苛养菌存在的聚合酶链反应（PCR）。该研究纳入了1994年4月至2004年12月在法国马赛9年期间所见的1998例疑似IE病例。对他们进行了前瞻性评估。共有427例（21.4%）患者被诊断为确诊心内膜炎。261例（13%）病例被诊断为可能的心内膜炎。在397例（93%）病例中通过血培养、血清学检测以及对心脏瓣膜材料的检查分别确立了病因诊断，其中在348例（81.5%）确诊的IE病例、34例（8%）病例和15例（3.5%）病例中得以确立。两例患者同时感染了链球菌和伯氏考克斯体。血清学和类风湿因子评估结果将38例（8.9%）可能的心内膜炎病例重新分类为确诊病例。系统血清学检测提高了改良杜克标准的效能，并在8%（34/427）的IE病例中有助于确立病因诊断。
