Cardiovascular Pathology
Volume 19, Issue 3 , Pages 171-182 , May 2010

Cardiac infections: focus on molecular diagnosis

  • Fiorella Calabrese

      Affiliations

    • Corresponding Author InformationCorresponding author. Department of Diagnostic Medical Science and Special Therapies, University of Padua Medical School, Via A. Gabelli, 61-35121 Padua, Italy. Tel.: +39 0498272268; fax: +39 0498272269.
    • ,
  • Elisa Carturan
    • ,
  • Gaetano Thiene

Received 5 May 2009 ,Revised 24 September 2009 ,Accepted 28 September 2009.

References 

  1. Butany J. The pericardium and its diseases. In:  Silver DM editors. Cardiovascular pathology. New York: Churchill Livingstone; 1991;p. 847–894
  2. Friman G, Fohlman J. The epidemiology of viral heart disease. Scand J Infect Dis Suppl. 1993;88:7–10
  3. Barbaro G, Klatt EC. HIV infection and the cardiovascular system. AIDS Rev. 2002;4:93–103
  4. Spodick DH. Acute pericarditis: current concepts and practice. JAMA. 2003;289:1150–1153
  5. Troughton RW, Asher CR, Klein AL. Pericarditis. Lancet. 2004;363:717–727
  6. Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y, et al. Guidelines on the diagnosis and management of pericardial diseases executive summary; the task force on the diagnosis and management of pericardial diseases of the European Society of Cardiology. Eur Heart J. 2004;25:587–610
  7. Oh KY, Shimizu M, Edwards WD, Tazelaar HD, Danielson GK. Surgical pathology of the parietal pericardium: a study of 344 cases (1993-1999). Cardiovasc Pathos. 2001;10:157–168
  8. Maisch B, Ristic AD. The classification of pericardial disease in the age of modern medicine. Curr Cardiol Rep. 2002;4:13–21
  9. Lorbar M, Spodick DH. ‘Idiopathic’ pericarditis-the clinician's challenge. [nothing is idiopathic] Int J Clin Pract. 2007;61:138–142
  10. Levy PY, Fournier PE, Charrel R, Metras D, Habib G, Raoult D. Molecular analysis of pericardial fluid: a 7-year experience. Eur Heart J. 2006;27:1942–1946
  11. Permanyer-Miralda G, Sagristá-Sauleda J, Soler-Soler J. Primary acute pericardial disease: a prospective series of 231 consecutive patients. Am J Cardiol. 1985;56:623–630
  12. Maisch B, Risti AD, Seferovi PM. New directions in diagnosis and treatment of pericardial disease: an update by the Taskforce on pericardial disease of the World Heart Federation. Herz. 2000;25:769–780
  13. Estok L, Wallach F. Cardiac tamponade in a patient with AIDS: a review of pericardial disease in patients with HIV infection. Mt Sinai J Med. 1998;65:33–39
  14. Wragg A, Strang JI. Tuberculous pericarditis and HIV infection. Heart. 2000;84:127–128
  15. Tiruviluamala P, Reichman LB. Tuberculosis. Annu Rev Public Health. 2002;23:403–426
  16. Desai HN. Tuberculous pericarditis. A review of 100 cases. S Afr Med J. 1997;55:877–880
  17. Koh KK, Kim EJ, Cho CH, Choi MJ, Cho SK, Kim SS, et al. Adenosine deaminase and carcinoembryonic antigen in pericardial effusion diagnosis, especially in suspected tuberculous pericarditis. Circulation. 1994;89:2728–2735
  18. Bogard M, Vincelette J, Antinozzi R, Alonso R, Fenner T, Schirm J, et al. Multicenter study of a commercial, automated polymerase chain reaction system for the rapid detection of Mycobacterium tuberculosis in respiratory specimens in routine clinical practice. Eur J Clin Microbiol Infect Dis. 2001;20:724–731
  19. Hasaneen NA, Zaki ME, Shalaby HM, El-Morsi AS. Polymerase chain reaction of pleural biopsy is a rapid and sensitive method for the diagnosis of tuberculous pleural effusion. Chest. 2003;124:2105–2111
  20. Richardson P, McKenna W, Bristow M, Maisch B, Mautner B, O'Connell J, et al. Report of the 1995 WHO/ISFC task force on the definition of cardiomyopathies. Circulation. 1996;93:841–842
  21. Dec GW, Palacios IF, Fallon JT, Aretz HT, Mills J, Lee DC, et al. Active myocarditis in the spectrum of acute dilated cardiomyopathies. Clinical features, histologic correlates, and clinical outcome. N Engl J Med. 1985;312:885–890
  22. Basso C, Calabrese F, Corrado D, Thiene G. Postmortem diagnosis in sudden cardiac death victims: macroscopic, microscopic and molecular findings. Cardiovasc Res. 2001;50:290–300
  23. Martin AB, Webber S, Fricker FJ, Jaffe R, Demmler G, Kearney D, et al. Acute myocarditis. Rapid diagnosis by PCR in children. Circulation. 1994;90:330–339
  24. Calabrese F, Rigo E, Milanesi O, Boffa GM, Angelini A, Valente M, et al. Molecular diagnosis of myocarditis and dilated cardiomyopathy in children: clinicopathologic features and prognostic implications. Diagn Mol Pathol. 2002;11:212–221
  25. Dennert R, Crijns HJ, Heymans S. Acute viral myocarditis. Eur Heart J. 2008;29:2073–2082
  26. Baughman KL. Diagnosis of myocarditis: death of Dallas criteria. Circulation. 2006;113:593–595
  27. Cooper LT, Baughman KL, Feldman AM, Frustaci A, Jessup M, Kuhl U, et al. The role of endomyocardial biopsy in the management of cardiovascular disease: a scientific statement from the American Heart Association, the American College of Cardiology, and the European Society of Cardiology Endorsed by the Heart Failure Society of America and the Heart Failure Association of the European Society of Cardiology. Eur Heart J. 2007;28:3076–3093
  28. Woodruf JF. Viral myocarditis: a review. Am J Pathol. 1980;101:425–484
  29. Gauntt C, Godeney E, Lutton A, et al. Mechanism(s) of coxsackievirus-induced myocarditis in the mouse. In:  de la Maza L,  Pterson E editor. Medical virology. 8th ed.. Hillsdale (NJ): Lawrence Erlbaum; 1988;p. 161–182
  30. Rotbart H. Human enterovirus infections: molecular approaches to diagnosis and pathogenesis. In:  Semler B,  Ehrenfeld E editor. Molecular aspects of picornavirus infection and detection. Washington (DC): American Society for Microbiology; 1989;p. 243–264
  31. Bowles NE, Richardson PJ, Olsen EG, Archard LC. Detection of Coxsackie-B-virus-specific RNA sequences in myocardial biopsy samples from patients with myocarditis and dilated cardiomyopathy. Lancet. 1986;1:1120–1123
  32. Schmaltz AA, Apitz J, Hort W, Maisch B. Endomyocardial biopsy in infants and children: experience in 60 patients. Pediatr Cardiol. 1990;11:15–21
  33. Pophal SG, Sigfusson G, Booth KL, Bacanu SA, Webber SA, Ettedgui JA, et al. Complications of endomyocardial biopsy in children. J Am Coll Cardiol. 1999;34:2105–2110
  34. Akhtar N, Ni J, Stromberg D, Rosenthal GL, Bowles NE, Towbin JA. Tracheal aspirate as a substrate for polymerase chain reaction detection of viral genome in childhood pneumonia and myocarditis. Circulation. 1999;99:2011–2018
  35. Carturan E, Milanesi O, Kato Y, Giacometti C, Biffanti R, Thiene G, et al. Viral detection and tumor necrosis factor alpha profile in tracheal aspirates from children with suspicion of myocarditis. Diagn Mol Pathol. 2008;17:21–27
  36. Matsumori A, Matoba Y, Sasayama S. Dilated cardiomyopathy associated with hepatitis C virus infection. Circulation. 1995;92:2519–2525
  37. Schonian U, Crombach M, Maser S, Maisch B. Cytomegalovirus-associated heart muscle disease. Eur Heart J. 1995;S 16:46–49
  38. Klingel K, Selinka HC, Sauter M, Bock CT, Szalay G, Kandorlf R. Molecular mechanisms in enterovirus and parvovirus B19 associated myocarditis and inflammatory cardiomyopathy. Eur J S. 2002;4:9–12
  39. Kühl U, Pauschinger M, Noutsias M, Seeberg B, Bock T, Lassner D, et al. High prevalence of viral genomes and multiple viral infections in the myocardium of adults with “idiopathic” left ventricular dysfunction. Circulation. 2005;1117:887–893
  40. Caforio AL, Calabrese F, Angelini A, Tona F, Vinci A, Bottaro S, et al. A prospective study of biopsy-proven myocarditis: prognostic relevance of clinical and aetiopathogenetic features at diagnosis. Eur Heart J. 2007;28:1326–1333
  41. Mahrholdt H, Goedecke C, Wagner A, Meinhardt G, Athanasiadis A, Vogelsberg H, et al. Cardiovascular magnetic resonance assessment of human myocarditis: a comparison to histology and molecular pathology. Circulation. 2004;109:1250–1258
  42. Donoso Mantke O, Meyer R, Prösch S, Nitsche A, Leitmeyer K, Kallies R, et al. High prevalence of cardiotropic viruses in myocardial tissue from explanted hearts of heart transplant recipients and heart donors: a 3-year retrospective study from a German patients' pool. J Heart Lung Transplant. 2005;24:1632–1638
  43. Schenk T, Enders M, Pollak S, Hahn R, Huzly D. High prevalence of human parvovirus B19 DNA in myocardial autopsy samples from subjects without myocarditis or dilative cardiomyopathy. J Clin Microbiol. 2009;47:106–110
  44. Wang X, Zhang G, Liu F, Han M, Xu D, Zang Y. Prevalence of human parvovirus B19 DNA in cardiac tissues of patients with congenital heart diseases indicated by nested PCR and in situ hybridization. J Clin Virol. 2004;31:20–24
  45. Murry CE, Jerome KR, Reichenbach DD. Fatal parvovirus myocarditis in a 5-year-old girl. Hum Pathol. 2001;32:342–345
  46. Preston FE, Jarvis LM, Makris M, Philp L, Underwood JC, Ludlam CA, et al. Heterogeneity of hepatitis C virus genotypes in hemophilia: relationship with chronic liver disease. Blood. 1995;85:1259–1262
  47. Estrin M, Smith C, Huber S. Antigen-specific suppressor T cells prevent cardiac injury in BALB/c mice infected with a nonmyocarditic variant of coxsackievirus group B, type 3. AmJ Pathol. 1986;125:578–584
  48. Selinka HC, Wolde A, Pasch A, Klingel K, Schnorr JJ, Kupper JH, et al. Comparative analysis of two coxsackievirus B3 strains: putative influence of virus-receptor interactions on pathogenesis. J Med Virol. 2002;67:224–233
  49. Chapman NM, Tu Z, Tracy S, Gauntt CJ. An infectious cDNA copy of the genome of a non-cardiovirulent coxsackievirus B3 strain: its complete sequence analysis and comparison to the genomes of cardiovirulent coxsackieviruses. Arch Virol. 1994;135:115–130
  50. Cameron-Wilson CL, Pandolfino YA, Zhang HY, Pozzeto B, Archard LC. Nucleotide sequence of an attenuated mutant of coxsackievirus B3 compared with the cardiovirulent wildtype: assessment of candidate mutations by analysis of a revertant to cardiovirulence. Clin Diagn Virol. 1998;9:99–105
  51. Dunn JJ, Chapman NM, Tracy S, Romero JR. Genomic determinants of cardiovirulence in coxsackievirus B3 clinical isolates: localization to the 5′ non-translated region. J Virol. 2000;74:4787–4794
  52. Höfling K, Kim KS, Leser JS, Chapman NM, Willian S, Gauntt CJ, et al. Progress toward vaccines against virus that cause heart disease. Herz. 2000;25:286–290
  53. Lam KM, Oldenburg N, Khan MA, Gaylore V, Mikhail GW, Strouhal PD, et al. Significance of reverse transcription polymerase chain reaction in the detection of human cytomegalovirus gene transcripts in thoracic organ transplant recipients. J Heart Lung Transplant. 1998;17:555–565
  54. Pauschinger M, Bowles NE, Fuentes-Garcia FJ, Pham V, Kühl U, Schwimmbeck PL, et al. Detection of adenoviral genome in the myocardium of adult patients with idiopathic left ventricular dysfunction. Circulation. 1999;99:1348–1354
  55. Mason JW. Myocarditis and dilated cardiomyopathy: and inflammatory link. Cardiovasc Res. 2003;60:5–10
  56. Matsumori A. Cytokines in myocarditis and cardiomyopathies. Curr Opin Cardiol. 1996;11:302–309
  57. Calabrese F, Carturan E, Chimenti C, Pieroni M, Agostini C, Angelini A, et al. Overexpression of tumor necrosis factor (TNF)alpha and TNFalpha receptor I in human viral myocarditis: clinicopathologic correlations. Mod Pathol. 2004;17:1108–1118
  58. Why HJ, Meany BT, Richardson PJ, Olsen EG, Bowles NE, Cunningham L, et al. Clinical and prognostic significance of detection of enteroviral RNA in the myocardium of patients with myocarditis or dilated cardiomyopathy. Circulation. 1994;89:2582–2589
  59. Figulla HR, Stille-Siegener M, Mall G, Heim A, Kreuzer H. Myocardial enterovirus infection with left ventricular dysfunction: a benign disease compared with idiopathic dilated cardiomyopathy. J Am Coll Cardiol. 1995;25:1170–1175
  60. Fujioka S, Kitaura Y, Ukimura A, Deguchi H, Kawamura K, Isomura T, et al. Evaluation of viral infection in the myocardium of patients with idiopathic dilated cardiomyopathy. J Am Coll Cardiol. 2000;36:1920–1926
  61. Shirali GS, Ni J, Chinnock RE, Johnston JK, Rosenthal GL, Bowles NE, et al. Association of viral genome with graft loss in children after cardiac transplantation. N Engl J Med. 2000;344:1498–1503
  62. Bowles NE, Ni J, Kearney DL, Pauschinger M, Schultheiss HP, McCarthy R, et al Detection of viruses in myocardial tissues by polymerase chain reaction. Evidence of adenovirus as a common cause of myocarditis in children and adults. J Am Coll Cardiol. 2003;42:466–472
  63. Kuethe F, Sigusch HH, Hilbig K, Tresselt C, Glück B, Egerer R, et al. Detection of viral genome in the myocardium: lack of prognostic and functional relevance in patients with acute dilated cardiomyopathy. Am Heart J. 2007;153:850–885
  64. Kindermann I, Kindermann M, Kandolf R, Klingel K, Bültmann B, Müller T, et al. Predictors of outcome in patients with suspected myocarditis. Circulation. 2008;118:639–648
  65. Kühl U, Pauschinger M, Schwimmbeck PL, Seeberg B, Lober C, Noutsias M, et al. Interferon-beta treatment eliminates cardiotropic viruses and improves left ventricular function in patients with myocardial persistence of viral genomes and left ventricular dysfunction. Circulation. 2003;107:2793–2798
  66. Daliento L, Calabrese F, Tona F, Caforio AL, Tarsia G, Angelini A, et al. Successful treatment of enterovirus-induced myocarditis with interferon-alpha. J Heart Lung Transplant. 2003;22:214–217
  67. Mason JW, O'Connell JB, Herskowitz A. A clinical trial of immunosuppressive and immunomodulatory treatment for myocarditis. N Engl J Med. 1995;333:269–275
  68. Maish B, Hufnagel G, Schonian U, Hengstenberg C for the ESETCID investigators. The European study of epidemiology and treatment of cardiac inflammatory disease (ESETCID). Eur Heart J. 1995;S16:172–175
  69. Frustaci A, Calabrese F, Chimenti C, Pieroni M, Thiene G, Maseri AA. Immunosopressive therapy for active lymphocythic myocarditis: virologic and immunologic profile of responders versus non responders. Circulation. 2003;107:857–863
  70. Wojnicz R, Nowalany-Kozielska E, Wojciechowska C, Glanowska G, Wilczewski P, Niklewski T, et al. Randomized, placebo-controlled study for immunosuppressive treatment of inflammatory dilated cardiomyopathy: two-year follow-up results. Circulation. 2001;104:39–45
  71. Horstkotte D, Follath F, Gutschik E, Lengyel M, Oto A, Pavie A, et al. Guidelines on prevention, diagnosis and treatment of infective endocarditis executive summary; the task force on infective endocarditis of the European society of cardiology. Eur Heart J. 2004;25:267–276
  72. Thiene G, Basso C. Pathology and pathogenesis of infective endocarditis in native heart valves. Cardiovasc Pathol. 2006;15:256–263
  73. Silver MD. Infective endocarditis. In:  Silver MD editors. Cardiovascular pathology. New York: Churchill Livingstone; 1991;p. 895–932
  74. Prendergast BD. The changing face of infective endocarditis. Heart. 2006;92:879–885
  75. Hoen B. Epidemiology and antibiotic treatment of infective endocarditis: an update. Heart. 2006;92:1694–1700
  76. Mylonakis E, Calderwood SB. Infective endocarditis in adults. N Engl J Med. 2001;345:1318–1330
  77. Beynon RP, Bahl VK, Prendergast BD. Infective endocarditis. BMJ. 2006;333:334–339
  78. Millar BC, Moore JE. Antibiotic prophylaxis, body piercing and infective endocarditis. J Antimicrob Chemother. 2004;53:123–126
  79. Valencia E, Miró J. Endocarditis in the setting of HIV infection. AIDS Rev. 2004;6:97–106
  80. Durack DT, Lukes AS, Bright DK. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. Am J Med. 1994;96:200–209
  81. Li JS, Sexton DJ, Mick N, Nettles R, Fowler VG, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis. 2000;30:633–638
  82. Millar BC, Moore JE. Current trends in the molecular diagnosis of infective endocarditis. Eur J Clin Microbiol Infect Dis. 2004;23:353–365
  83. Goldenberger D, Künzli A, Vogt P, Zbinden R, Altwegg M. Molecular diagnosis of bacterial endocarditis by broad-range PCR amplification and direct sequencing. J Clin Microbiol. 1997;35:2733–2739
  84. Millar B, Moore J, Mallon P, Xu J, Crowe M, Mcclurg R, et al. Molecular diagnosis of infective endocarditis—a new Duke's criterion. Scand J Infect Dis. 2001;33:673–680
  85. Moore JE, Millar BC, Yongmin X, Woodford N, Vincent S, Goldsmith CE, et al. Molecular identification of Acinetobacter sp. in a patient with culture-negative endocarditis. Clin Microbiol Infect. 2000;6:277–278
  86. Hryniewiecki T, Gzyl A, Augustynowicz E, Rawczynska-Englert I. Development of broad-range polymerase chain reaction (PCR) bacterial identification in diagnosis of infective endocarditis. J Heart Valve Dis. 2002;11:870–874
  87. Grijalva M, Horváth R, Dendis M, Erný J, Benedík J. Molecular diagnosis of culture negative infective endocarditis: clinical validation in a group of surgically treated patients. Heart. 2003;89:263–268
  88. Bosshard PP, Kronenberg A, Zbinden R, Ruef C, Böttger EC, Altwegg M. Etiologic diagnosis of infective endocarditis by broad-range polymerase chain reaction: a 3-year experience. Clin Infect Dis. 2003;37:167–172
  89. Gauduchon V, Chalabreysse L, Etienne J, Célard M, Benito Y, Lepidi H, et al. Molecular diagnosis of infective endocarditis by PCR amplification and direct sequencing of DNA from valve tissue. J Clin Microbiol. 2003;41:763–766
  90. Podglajen I, Bellery F, Poyart C, Coudol P, Buu-Hoï A, Bruneval P, et al. Comparative molecular and microbiologic diagnosis of bacterial endocarditis. Emerg Infect Dis. 2003;9:1543–1547
  91. Lang S, Watkin RW, Lambert PA, Bonser RS, Littler WA, Elliott TS. Evaluation of PCR in the molecular diagnosis of endocarditis. J Infect. 2004;48:269–275
  92. Lang S, Watkin RW, Lambert PA, Littler WA, Elliott TS. Detection of bacterial DNA in cardiac vegetations by PCR after the completion of antimicrobial treatment for endocarditis. Clin Microbiol Infect. 2004;10:579–581
  93. Greub G, Lepidi H, Rovery C, Casalta JP, Habib G, Collard F, et al. Diagnosis of infectious endocarditis in patients undergoing valve surgery. Am J Med. 2005;118:230–238
  94. Breitkopf C, Hammel D, Scheld HH, Peters G, Becker K. Impact of a molecular approach to improve the microbiological diagnosis of infective heart valve endocarditis. Circulation. 2005;111:1415–1421
  95. Rovery C, Greub G, Lepidi H, Casalta JP, Habib G, Collart F, et al. PCR detection of bacteria on cardiac valves of patients with treated bacterial endocarditis. J Clin Microbiol. 2005;43:163–167
  96. Kotilainen P, Heiro M, Jalava J, Rantakokko V, Nikoskelainen J, Nikkari S, et al. Aetiological diagnosis of infective endocarditis by direct amplification of rRNA genes from surgically removed valve tissue. An 11-year experience in a Finnish teaching hospital. Ann Med. 2006;38:263–273
  97. Marín M, Muñoz P, Sánchez M, del Rosal M, Alcalá L, Rodríguez-Créixems M, et al. Molecular diagnosis of infective endocarditis by real-time broad-range polymerase chain reaction (PCR) and sequencing directly from heart valve tissue. Medicine (Baltimore). 2007;86:195–202
  98. Voldstedlund M, Nørum Pedersen L, Baandrup U, Klaaborg KE, Fuursted K. Broad-range PCR and sequencing in routine diagnosis of infective endocarditis. APMIS. 2008;116:190–198
  99. Lisby G, Gutschik E, Durack DT. Molecular methods for diagnosis of infective endocarditis. Infect Dis Clin North Am. 2002;16:393–412
  100. Prendergast BD. Diagnostic criteria and problems in infective endocarditis. Heart. 2004;90:611–613
  101. Shin GY, Manuel RJ, Ghori S, Brecker S, Breathnach AS. Molecular technique identifies the pathogen responsible for culture negative infective endocarditis. Heart. 2005;e47:91
  102. Ben-Ami R, Giladi M, Carmeli Y, Orni-Wasserlauf R, Siegman-Igra Y. Hospital-acquired infective endocarditis: should the definition be broadened?. Clin Infect Dis. 2004;38:843–850
  103. Moreillon P, Que YA. Infective endocarditis. Lancet. 2004;363:139–149
  104. Relman DA, Schmidt TM, MacDermott RP, Falkow S. Identification of the uncultured bacillus of Whipple's disease. N Engl J Med. 1992;327:293–301
  105. Bayer PD, Scheld WM. Endocarditis and intravascular infections. In Mandell GL, Bennett JE, Dolin R (eds.), Principles and practices of infectious diseases, vol. 1, 5th ed. New York, NY: Churchill Livingstone, 2000. p.857-902.
  106. Presterl E, Grisold AJ, Reichmann S, Hirschl AM, Georgopoulos A, Graninger W. Viridans streptococci in endocarditis and neutropenic sepsis: biofilm formation and effects of antibiotics. J Antimicrob Chemother. 2005;55:45–50
  107. Chu VH, Sexton DJ, Cabell CH, Reller LB, Pappas PA, Singh RK, et al. Repeat infective endocarditis: differentiating relapse from reinfection. Clin Infect Dis. 2005;41:406–409
  108. Rothman RE, Majmudar MD, Kelen GD, Madico G, Gaydos CA, Walker T, et al. Detection of bacteremia in emergency department patients at risk for infective endocarditis using universal 16S rRNA primers in a decontaminated polymerase chain reaction assay. J Infect Dis. 2002;186:1677–1681
  109. Lamas CC, Eykyn SJ. Suggested modifications to the Duke criteria for the clinical diagnosis of native valve and prosthetic valve endocarditis: analysis of 118 pathologically proven cases. Clin Infect Dis. 1997;25:713–719
  110. Fournier PE, Casalta JP, Habib G, Messana T, Raoult D. Modification of the diagnostic criteria proposed by the Duke Endocarditis Service to permit improved diagnosis of Q fever endocarditis. Am J Med. 1996;100:629–633
  111. Houpikian P, Raoult D. Diagnostic methods current best practices and guidelines for identification of difficult-to-culture pathogens in infective endocarditis. Infect Dis Clin North Am. 2002;16:377–392
  112. Lepidi H, Durack DT, Raoult D. Diagnostic methods current best practices and guidelines for histologic evaluation in infective endocarditis. Infect Dis Clin North Am. 2002;16:339–361

PII: S1054-8807(09)00113-6

doi: 10.1016/j.carpath.2009.09.010

Cardiovascular Pathology
Volume 19, Issue 3 , Pages 171-182 , May 2010

Article Tools

* Image Usage & Resolution