Samples from all 19 BCNE patients were tested by serologic methods, molecular methods, or both.
In Morocco, cases of BCNE represent two thirds of all cases of infectious endocarditis and constitute a major problem of diagnosis and management of patients (1).
Particular attention was also paid to the BCNE patients as these patients may have risk factors warranting Q fever screening.
The differences in clinical risk factors between suspected and unsuspected BCNE patients were analyzed with Chi-squared test or Chi-squared test with Yates' correction for continuity.
The remaining 147 (23.1%) cases were BCNE on unknown cause, of which 11 patients (7.5% of BCNE cases) were suspected of Q fever and underwent Q fever serological analysis by IFAA.
To understand the reasoning behind the low Q fever endocarditis diagnostic rate, we examined the clinical characteristics of the BCNE patients.
First, in our review of BCNE patients, the presence of Q fever risk factors was similar across unsuspected and suspected patient groups, suggesting special attention should be paid to BCNE patients as a whole.
Of the 147 cases with BCNE of unknown cause, empirical antibiotic therapy was given before admission.
Due to the limited cases of Q fever endocarditis found and few BCNE patients undergoing Q fever serological testing, definitive conclusions cannot be made from this study.
In 2002, BCNE developed, requiring mechanical aortic and mitral valve replacements.
However, because the Duke criteria are insensitive for BCNE diagnosis, it has been proposed that a Bartonella IgG titer of >1:800 and a positive Western blot or PCR analysis when using valve or blood specimens should be considered major Duke criteria (5).