Fluorescence in situ hybridization to improve the diagnosis of endocarditis: a pilot study

Infective endocarditis is a rare but life-threatening disease associated with high mortality. Early diagnosis of the causative microorganism is critical to patient outcome. However, conventional diagnostic methods are often unsatisfactory in achieving this goal. As a proof of concept, we applied flu...

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Bibliographic Details
Published in:	Clinical microbiology and infection Vol. 16; no. 6; pp. 767 - 773
Main Authors:	Mallmann, C., Siemoneit, S., Schmiedel, D., Petrich, A., Gescher, D.M., Halle, E., Musci, M., Hetzer, R., Gö bel, U.B., Moter, A.
Format:	Journal Article
Language:	English
Published:	Oxford, UK Elsevier Ltd 01-06-2010 Blackwell Publishing Ltd Wiley-Blackwell Elsevier Limited
Subjects:	Bacteria Bacteria - classification Bacteria - genetics Bacteria - isolation & purification Bacteriological Techniques - methods Bartonella Biological and medical sciences Biopsy blood culture-negative Cardiology. Vascular system Endocardial and cardiac valvular diseases endocarditis Endocarditis, Bacterial - diagnosis Heart heart valve Heart Valves - microbiology Histocytochemistry Humans in situ hybridization In Situ Hybridization, Fluorescence - methods Infectious diseases Medical sciences Medical treatment Mortality Pilot Projects Sensitivity and Specificity Tropheryma whipplei Valves Bartonella endocarditis blood culture-negative Tropheryma whipplei heart valve in situ hybridization In situ Cardiovascular disease Heart valve Infection Microbiological investigation Heart disease Endocardial disease Endocarditis Fluorescence in situ hybridization Bacteria Bartonellaceae Diagnosis Blood culture
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Summary:	Infective endocarditis is a rare but life-threatening disease associated with high mortality. Early diagnosis of the causative microorganism is critical to patient outcome. However, conventional diagnostic methods are often unsatisfactory in achieving this goal. As a proof of concept, we applied fluorescence in situ hybridization (FISH) for detection and identification of bacteria in histological sections of heart valves. Biopsy specimens from 54 suspected endocarditis patients were obtained during valve surgery and analysed via FISH. Specimens were screened with a probe panel that identifies the most common bacteria implicated in endocarditis. Results were compared with those of culture-based diagnostics and clinical data. Discrepant results were subjected to comparative sequence analysis of PCR-amplified 16S rRNA genes. FISH detected bacteria in 26 of the 54 heart valves. FISH allowed successful diagnosis of infective endocarditis in five of 13 blood culture-negative cases and in 11 of 37 valve culture-negative cases, showing the bacteria within their histological context. This technique allows the simultaneous detection and identification of microorganisms at the species or genus level directly from heart valves and might be a valuable tool for diagnosis of endocarditis.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1198-743X 1469-0691
DOI:	10.1111/j.1469-0691.2009.02936.x