Nirmal Dinesh, Brown Bernard, Silverstein Noah, Trimmingham Andrea, McFarlane Samy I
Internal Medicine, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, USA.
Cureus. 2024 Oct 3;16(10):e70775. doi: 10.7759/cureus.70775. eCollection 2024 Oct.
Endocarditis is a serious diagnostic entity that carries a high rate of morbidity and mortality, with complications including heart failure, septic embolization, brain abscesses, and stroke. Blood culture-negative endocarditis (BCNE) represents a particularly challenging clinical scenario where the causative organism is undetectable, either due to being difficult to culture or due to the empiric administration of antimicrobial agents. This entity generally results in delayed diagnosis and treatment of endocarditis, with a potential increase in the rate of complications. In this report, we present a case of multiple brain abscesses resulting from BCNE, where the causative organism - and hence effective treatment - was only identified with the implementation of modern molecular diagnostic techniques like Karius, isothermal amplification methods, etc. We also highlight the specific entities of BCNE, its pathogenesis, and differential diagnosis, as well as the effective diagnostic and therapeutic options available to date.
心内膜炎是一种严重的诊断实体，具有很高的发病率和死亡率，其并发症包括心力衰竭、脓毒性栓塞、脑脓肿和中风。血培养阴性的心内膜炎（BCNE）代表了一种特别具有挑战性的临床情况，即由于病原体难以培养或由于经验性使用抗菌药物，导致无法检测到致病微生物。这种情况通常会导致心内膜炎的诊断和治疗延迟，并发症发生率可能会增加。在本报告中，我们介绍了一例由BCNE引起的多发性脑脓肿病例，其中致病微生物——以及有效的治疗方法——直到采用现代分子诊断技术如Karius、等温扩增方法等才得以确定。我们还强调了BCNE的具体情况、发病机制、鉴别诊断，以及迄今为止可用的有效诊断和治疗选择。
