Blood Culture-Negative Endocarditis

Blood culture-negative endocarditis is often severe and difficult to diagnose. Infective blood culture-negative endocarditis is classified into three main categories: (1) bacterial endocarditis with blood cultures sterilized by previous antibacterial treatment; (2) endocarditis related to fastidious microorganisms in which prolonged incubation is necessary; (3) true blood culture-negative endocarditis, due to intra-cellular bacteria that cannot be routinely cultured in blood with currently available. There are two major etiologies for noninfective endocarditis: (1) nonbacterial thrombotic endocarditis and (2) endocarditis related to systemic diseases (SLE and Behcet disease). Team approach including cardiologists, infection disease (ID) specialists, microbiologists, pathologist and immunologist is crucial for diagnosis and management of blood culture-negative endocarditis as it needs elegant and high-quality modern technics of histology, molecular analysis and essential epidemiological information.