Histology

In cases of suspected IE for which the causative organism is not known prior to surgical intervention, heart valve material should be submitted for further investigation by histology and culture. Because of preceding antibiotic therapy, bacterial cultures of valve tissue obtained at surgery are positive in only a minority (10-15%) of cases. Histologic examination of excised valve tissue can be used both to confirm the diagnosis of IE and to determine the probable causative organism. Pathologic findings compatible with IE are considered to be evidence of definite endocarditis within the modified Duke criteria.

Routine stains, including H&E and tissue Gram stains, will show infiltrates of inflammatory cells and can allow common causative organisms to be visualized. Special stains, including Warthin-Starry (Bartonella spp.), periodic acid-Schiff (T. whipplei, fungi), Gimenez (C. burnetti, Legionella spp.), and Gomori methenamine silver (fungi) stains, are needed for detection of less common causes of IE.

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