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However, the blood culture may contain a bacterium rarely associated with endocarditis, such as Lactobacillus spp., Klebsiella spp., or nontoxigenic Corynebacterium, Salmonella, Gemella, Campylobacter, Aeromonas, Yersinia, Nocardia, Pasteurella, Listeria, or Erysipelothrix spp., that requires further investigation to establish the relationship with endocarditis, or the blood culture may be uninformative despite a supportive clinical evaluation. In the latter case, the etiologic agents are either fastidious extracellular or intracellular bacteria. Fastidious extracellular bacteria such as Abiotrophia, HACEK group bacteria, Clostridium, Brucella, Legionella, Mycobacterium, and Bartonella spp. need supplemented media, prolonged incubation time, and special culture conditions. Intracellular bacteria such as Coxiella burnetii cannot be isolated routinely. The two most prevalent etiologic agents of culture-negative endocarditis are C. burnetti and Bartonella spp. Their diagnosis is usually carried out serologically. A systemic pathologic examination of excised heart valves including periodic acid-Schiff (PAS) staining and molecular methods has allowed the identification of Whipple's bacillus endocarditis. Pathologic examination of the valve using special staining, such as Warthin-Starry, Gimenez, and PAS, and broad-spectrum PCR should be performed systematically when no etiologic diagnosis is evident through routine laboratory evaluation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1128\/cmr.14.1.177-207.2001","type":"journal-article","created":{"date-parts":[[2002,7,27]],"date-time":"2002-07-27T05:55:30Z","timestamp":1027749330000},"page":"177-207","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":604,"title":["Endocarditis Due to Rare and Fastidious Bacteria"],"prefix":"10.1128","volume":"14","author":[{"given":"P.","family":"Brouqui","sequence":"first","affiliation":[{"name":"<!--label omitted: 1-->Unit\u00e9 des Rickettsies, CNRS UPRESA 6020, Facult\u00e9 de M\u00e9decine, 13385 Marseille Cedex 5, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Raoult","sequence":"additional","affiliation":[{"name":"<!--label omitted: 1-->Unit\u00e9 des Rickettsies, CNRS UPRESA 6020, Facult\u00e9 de M\u00e9decine, 13385 Marseille Cedex 5, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_2_2_2","unstructured":"Reference deleted."},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1080\/17843286.1995.11718454"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0033-0620(05)80040-4"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.98.6.1532"},{"key":"e_1_3_2_6_2","first-page":"372","article-title":"Apyrexic Brucella melitensis aortic valve endocarditis.","volume":"41","author":"al-Mudallal D. 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