Ghidey Fisseha Y, Igbinosa Osamuyimen, Mills Kristin, Lai Leon, Woods Christian, Ruiz Maria E, Fishbein Dawn, Sampath Rahul, Lowery Robert, Wortmann Glenn
Infectious Disease Section, MedStar Washington Hospital Center , Washington , USA.
Mayo Clinical Laboratory , Rochester, MN , USA.
JMM Case Rep. 2016 Aug 30;3(4):e005049. doi: 10.1099/jmmcr.0.005049. eCollection 2016 Aug.
Prior studies (predominantly from Europe) have demonstrated blood culture-negative endocarditis due to . Our objective was to describe three cases of endocarditis identified within one year at a large hospital in Washington, DC, USA.
We constructed a descriptive case series from a retrospective review of medical records from April to December 2013 at an 800-bed urban hospital. All three patients (ages: 52, 55 and 57 years) were undomiciled/homeless men with a history of alcoholism. Although they had negative blood cultures, echocardiography demonstrated aortic/mitral valve perforation and regurgitation in one patient, aortic/mitral valve vegetation with mitral regurgitation in the second patient, and aortic valve vegetation with regurgitation in the third patient. The patients had positive serum immunoglobulin G (IgG) with negative immunoglobulin M (IgM). PCR on DNA extracted from cardiac valves was positive for , and DNA sequencing of PCR amplicons identified . Patients received treatment with doxycycline/rifampin or doxycycline/gentamicin.
Clinicians should consider endocarditis as a differential diagnosis in patients who fit elements of the Duke Criteria, as well as having a history of homelessness and alcoholism.
先前的研究（主要来自欧洲）已证明存在由……引起的血培养阴性的心内膜炎。我们的目标是描述在美国华盛顿特区一家大型医院一年内确诊的3例……心内膜炎病例。
我们通过回顾一家拥有800张床位的城市医院2013年4月至12月的病历构建了一个描述性病例系列。所有3例患者（年龄分别为52岁、55岁和57岁）均为无固定住所/无家可归的男性，有酗酒史。尽管他们的血培养结果为阴性，但超声心动图显示，1例患者存在主动脉瓣/二尖瓣穿孔及反流，第2例患者有主动脉瓣/二尖瓣赘生物伴二尖瓣反流，第3例患者有主动脉瓣赘生物伴反流。患者血清免疫球蛋白G（IgG）呈阳性，免疫球蛋白M（IgM）呈阴性。从心脏瓣膜提取的DNA进行的聚合酶链反应（PCR）检测结果为……阳性，PCR扩增产物的DNA测序鉴定出……。患者接受了强力霉素/利福平或强力霉素/庆大霉素治疗。
临床医生在诊断符合杜克标准且有流浪及酗酒史的患者时，应将……心内膜炎作为鉴别诊断之一。
