What are the current issues associated with proposing antibody titers that are positive for Bartonella and Chlamydia species or PCR-based testing for T whippelii as a major criterion in the Duke schema?
The current issues associated with proposing antibody titers that are positive for Bartonella and Chlamydia species or PCR-based testing for T whippelii as a major criterion in the Duke schema include low sensitivity of PCR unless cardiac valvular tissue is available for testing, few centers providing timely PCR-based testing for these rare causes of IE, and the lack of standardization and validation of serodiagnostic and PCR approaches in a sufficient number of cases of these rare types of IE. Additionally, the availability of such assays is not yet widespread. Therefore, the inclusion of these assays as major criteria should be deferred until these issues are addressed.