A fatal case of Legionella micdadei prosthetic valve endocarditis diagnosed by plasma microbial cell-free DNA metagenomic sequencing.

A fatal Legionella micdadei prosthetic valve endocarditis case was diagnosed using plasma microbial cell-free DNA metagenomic next-generation sequencing, confirmed by valve tissue culture.

• Why it matters: Culture-negative endocarditis can be missed by conventional testing, and current guidance does not address timely diagnosis for patients likely to rapidly deteriorate.
• What they did: In an immunocompromised patient, clinicians used plasma mcfDNA-mNGS to identify the pathogen and confirmed it with buffered charcoal yeast extract culture of valve tissue.
• The result: The case supports expanding mcfDNA-mNGS use in culture-negative endocarditis and motivates a framework for when to pursue early metagenomic testing despite limitations and cost.

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