Today, we reviewed a case of an older man who had presented several times with "recurrent pneumonia" who was diagnosed with Bartonella endocarditis (culture-negative endocarditis), who eventually was found to have strep sanguis endocarditis on histology after surgery.

Learning Points:

  • For acute endocarditis think: infection of normal valves with virulent organism (S. aureus, beta hemolytic strep, strep pneumo). For subacute endocarditis think: indolent infection of abnormal valves with less virulent organism (S. viridans).
  • Culture negative endocarditis think: previous administration of antimicrobials, infection with highly fastidious bacteria or non-bacterial pathogens (fungi).

Our patient had known exposures to cattle, sheep, goats, dogs and cats, warranting further evaluation for Bartonella, Brucella, and Coxiella.

  • Below is a table from UpToDate of the ACC/AHA guideline summary of surgery for native valve endocarditis.

Dr. Hegarty referenced a well known study by Kang published in the NEJM that reviewed early surgery versus conventional treatment. The conclusion of that study was, "early surgery, as compared with conventional treatment, significantly reduced the composite end point of death from any cause or embolic events by effectively reducing the risk of systemic embolism among patients with infective endocarditis and large vegetations."