INFECTIVE ENDOCARDITIS BY UNUSUAL MICROOR GANISMS

All series of infective endocarditis had a variable proportion of case s without an etiologic agent because all cultures were negative. New m icrobiologic techniques have permitted the discovery of the role of ma ny microorganisms in infective endocarditis. C. burnetii is an increas ing causative agent of subacute infective endocarditis. In the diagnos is, to the detection of antiphase-I antibodies, immunohistochemical, m olecular techniques and cellular cultures have been added. Total cure is difficult to obtain. The combination of doxicicline plus ciprofloxa cin for at least 3 years has been proposed as the treatment of choice. Surgery must be reserved for patients with cardiac insufficiency. Les s than 2% of cases of acute brucellosis are complicate with infective endocarditis. Infective endocarditis produces serious and rapid valvul ar destruction with high mortality rates if valve surgery is not perfo rmed. For medical treatment at least 3 active agents are required. Bar tonella has, recently been described as an etiologic agent of infectiv e endocarditis. It mainly affects to homeless people living in poor hy gienic conditions. The aortic valve is most commonly involved and, fre quently, valve insufficiency requires valve replacement, Blood culture isolation needs long incubation periods. Parenteral nutrition, immuno suppression, Ride spectrum antibiotic regimens, intravenous drug addic tion and cardiovascular surgery are risk factors previously described in the development of fungal endocarditis. C. albicans and Aspergillus spp. are most frequent etiologic agents. Infective endocarditis shoul d be suspected in any patient with systemic fungal disease. Blood cult ures are often negative except for Candida spp. Peripheral emboli and large vegetations are frequent. Mortality is high, anti-fungal therapy combined with surgery is the treatment of choice. Legionella, Mycopla sma, Chlamydia, Mycobacteria, viruses are potential agents of infectiv e endocarditis, and difficult to diagnose because of special culture r equirements. Epidemiological clues, serologic and molecular techniques and blood cultures could identify them.