The diagnosis of endocarditis is based on positive blood culture results and echocardiographic evidence of valvular injury or vegetations. Three separate cultures from different veins should be obtained. Aerobic, anaerobic, and fungal cultures should be obtained before antibiotics are started. Echocardiography is helpful but should not delay appropriate stabilizing treatments. Transesophageal echocardiography is preferred, but in experienced centers transthoracic echocardiography may suffice. Evidence of vasculitis or embolic events contributes to the clinical diagnosis. Nonspecific laboratory findings that support the diagnosis of endocarditis include leukocytosis, elevated C-reactive proteins, positive rheumatoid factor, normocytic anemia, hematuria (25 to 50 percent), and pyuria.
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