Approach to diagnostic evaluation in patients with suspected blood culture-negative endocarditis

BCNE: blood culture-negative endocarditis; IE: infectious endocarditis; PCR: polymerase chain reaction.

* Refer to topics on treatment of native endocarditis and prosthetic valve endocarditis, sections on culture-negative endocarditis for further discussion.

¶ Send serum for serology; send plasma and/or serum for PCR.

Δ Microbiology studies should include Gram stain bacterial culture (aerobic and anaerobic), fungal culture, and mycobacterial culture. Histopathology should include general and specific stains guided by epidemiologic risk factors; refer to text for further discussion.