**Culture Negative Endocarditis: Advances in Diagnosis and Treatment Culture Negative Endocarditis: Advances in Diagnosis and Treatment**

Marion J. Skalweit Marion J. Skalweit

Additional information is available at the end of the chapter Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/64920

#### **Abstract**

Culture-negative endocarditis (CNE) is a challenging clinical entity, both diagnostically and therapeutically. In this chapter, the changed epidemiology and microbiology of CNE are reviewed with cases highlighting typical pathogens in patients pre-treated with antibiotics, less common fastidious pathogens such as bacteria of the HACEK group, nutritionally deficient bacteria, *Legionella* spp. and Mycobacteria, "quintessential" CNE pathogens such as *Bartonella* spp., *Coxiella burnetti* and *Tropheryma* whipplei, as well as fungal CNE. Contemporary diagnostic methods are reviewed including polymerase chain reaction-based pathogen 16s RNA amplification coupled with electrospray ionization mass spectrometry (PCR/ESI-MS). Finally, treatment options per the recently updated 2015 American Heart Association and European Society for Cardiology guideline are presented.

**Keywords:** culture-negative endocarditis, *Bartonella* spp., *Coxiella burnetti* and *Tropher‐ yma whipplei*, PCR/ESI-MS
