{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T05:57:09Z","timestamp":1790575029449,"version":"4.1.0"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Syphilitic endocarditis, a rare complication of tertiary syphilis, poses diagnostic challenges due to the unculturable nature of\n                      <jats:italic>Treponema pallidum<\/jats:italic>\n                      and non-specific clinical manifestations. This report highlights the role of quantitative metagenomic next-generation sequencing (Q-mNGS) in confirming the diagnosis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>\n                      A 52-year-old male patient with a bicuspid aortic valve presented with a cough and chest tightness. Serology confirmed syphilis, but blood cultures were negative. Transesophageal echocardiography revealed severe aortic regurgitation with vegetations. Q-mNGS of resected valve tissue detected\n                      <jats:italic>T. pallidum<\/jats:italic>\n                      despite negative Warthin\u2013Starry staining. The patient underwent valve replacement and received penicillin G, with no recurrence at the 2-year follow-up.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Q-mNGS shows potentially higher sensitivity for diagnosing syphilitic endocarditis compared to traditional methods. Serological screening combined with molecular techniques is critical for culture-negative endocarditis in high-risk populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1911873","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T05:44:15Z","timestamp":1790574255000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Syphilitic bicuspid aortic valve endocarditis diagnosed by metagenomic next-generation sequencing: a case report and literature review"],"prefix":"10.3389","volume":"13","author":[{"given":"Zelei","family":"Ye","sequence":"first","affiliation":[{"name":"Department of Cardiac Surgery, The First Affiliated Hospital of Wenzhou Medical University","place":["Wenzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuxiang","family":"Liao","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, The First Affiliated Hospital of Wenzhou Medical University","place":["Wenzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zichen","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, The First Affiliated Hospital of Wenzhou Medical University","place":["Wenzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shijia","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, The First Affiliated Hospital of Wenzhou Medical University","place":["Wenzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiaoqing","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, The First Affiliated Hospital of Wenzhou Medical University","place":["Wenzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peifeng","family":"Jin","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, The First Affiliated Hospital of Wenzhou Medical University","place":["Wenzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"336","DOI":"10.1016\/S0140-6736(22)02348-0","article-title":"Syphilis","volume":"402","author":"Peeling","year":"2023","journal-title":"Lancet"},{"key":"B2","first-page":"S189","article-title":"S\u00edfilis cardiovascular: diagn\u00f3stico y tratamiento cardiovascular syphilis: diagnosis, treatment","volume":"76","author":"Carrada-Bravo","year":"2006","journal-title":"Arch Cardiol Mex"},{"key":"B3","doi-asserted-by":"publisher","first-page":"104.e9","DOI":"10.1016\/j.cjca.2018.11.009","article-title":"Infective endocarditis due to 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