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Bartonella quintana is a fastidious microorganism associated with blood culture negative endocarditis. In this study, 40 sera with cross-reactivity between Chlamydia species from patients from Sfax, Tunisia, were serologically tested for Bartonella. Thirteen sera were positive for Bartonella with IgG titers 
1:800. Western blot and cross-absorption confirmed the diagnosis of Bartonella quintana endocarditis in 12 cases and Bartonella henselae endocarditis in 1 case. These sera were also positive by LightCycler nested PCR amplification for the rnpb (7 of 13) and fur (11of 13) genes. Eleven patients had a definite diagnosis of endocarditis, which represents 9.8% of all endocarditis. Because Bartonella endocarditis seems to be very common in Tunisia, we suggest that its serology be performed systematically whenever endocarditis is suspected.
Received August 26, 2004. Accepted for publication November 6, 2004.
Acknowledgments: The authors thank Hachicha Sajiaa for his assistance to perform this work and E. Mathai for reviewing the manuscript. Among potential conflicts of interest, D. Raoult has deposed a patent on serological diagnosis of infective endocarditis, mainly based on the article: Rolain JM, Lecam C, Raoult D. Simplified serological diagnosis of endocarditis due to Coxiella burnetii and Bartonella.
Clin Diagn Lab Immunol 2003;10(6):1147–1148.
Authors’ addresses: Abir Znazen, Unitè des Rickettsies, Centre National de la Recherche Scientifique, Unitè Mixte de Recherche 6020, Facultè de Mèdecine, Universitè de la Mèditerranèe. 27 Boulevard Jean Moulin, 13385 Marseille Cedex 05, France et Laboratoire de Microbiologie, Centro Hospitalo-Universitaire Habib Bourguiba Sfax, Route El Ain Km 05, 3028 Sfax, Tunisia. Jean-Marc Rolain and Didier Raoult, Unitè des Rickettsies, Centre National de la Recherche Scientifique, Unitè Mixte de Recherche 6020, Facultè de Mèdecine, Universitè de la Mèditerranèe, 27 Boulevard Jean Moulin, 13385 Marseille Cedex 05, France, Telephone: 33-4-91-32-43-75, Fax: 33-4-38-77-72, E-mail: Didier.Raoult{at}medecine.univ-mrs.fr. Nader Hammami and Adnane Hammami, Laboratoire de Microbiologie, Centro Hospitalo-Universitaire Habib Bourguiba Sfax, Route El Ain Km 05, 3028 Sfax, Tunisia. Samir Kammoun, Service de Cardiologie, Centro Hospitalo-Universitaire Hedi Chaker Sfax, Route El Ain Km 05, 3028 Sfax, Tunisia.
Reprint requests: Didier Raoult, Unité des Rickettsies, CNRS UMR 6020, Université de la Méditerranée, Faculté de Médecine, Boulevard Jean Moulin, 13385 Marseille Cedex 05, France, Telephone: 00 33 4 91 32 43 75, Fax: 00 33 4 38 77 72, E-mail: Didier.Raoult{at}medecine.univ-mrs.fr.
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