Whipple’s Endocarditis: An Enigmatic Cause of Culture‐Negative Bacterial Endocarditis
Bibliographic record
Abstract
Case PresentationAn 80-year-old man living in Eastern Ontario was assessed at a local emergency department for a syncopal episode that occurred after awakening from sleep and ambulating to the bathroom.He had experienced malaise, anorexia and episodes of presyncope for four months.His medical history was significant for rheumatic fever in childhood without known cardiac sequelae, diverticulitis, hypertension and gastroesophageal reflux disease.A review of systems was notable for the absence of fever, weight loss, arthralgias, gastrointestinal (GI) and neurological complaints.The patient's medications were hydrochlorothiazide and rabeprazole.A transthoracic echocardiogram revealed a mobile mass on the aortic valve.There was no history of antimicrobial exposure within the preceding 12 months, and the patient denied illicit drug use, travel or exposure to animals.A physical examination revealed a systolic ejection murmur at the left upper sternal border.No stigmata of infective endocarditis (IE) were present.The remainder of the general examination was normal.A transesophageal echocardiogram revealed a 1.5 cm × 0.5 cm mobile mass on the right coronary cusp of the aortic valve and moderatesevere aortic insufficiency.Laboratory investigations were significant for normocytic anemia, with a hemoglobin level of 109 g/L and a serum albumin level of 39 g/L.The patient underwent mechanical aortic valve replacement for severe aortic insufficiency.Intraoperatively, the lesion appeared to be a vegetation of infectious origin, and valve specimens were sent for Gram stain and culture.Empirical antimicrobial therapy was initiated with ceftriaxone and vancomycin for presumed IE.Gross pathological examination revealed a thrombotic vegetation attached to the aortic valve.On high-power light microscopy, numerous small Gram-negative coccobacilli were observed along the margin of the vegetation, with no inflammatory cells present.Cultures from the valve and blood were negative after 21 days of incubation.Serologies for Bartonella henselae and Coxiella burnetii were negative.Broad-based 16S rDNA polymerase chain reaction (PCR)-based amplification and sequencing of the valvular tissue was requested through the Ontario Public Health Laboratory (Toronto, Ontario).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.010 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.005 |
| Scholarly communication | 0.003 | 0.004 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.004 | 0.004 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".