Volume 72, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


is a fastidious microorganism associated with blood culture negative endocarditis. In this study, 40 sera with cross-reactivity between species from patients from Sfax, Tunisia, were serologically tested for Thirteen sera were positive for with IgG titers ≥1:800. Western blot and cross-absorption confirmed the diagnosis of endocarditis in 12 cases and endocarditis in 1 case. These sera were also positive by LightCycler nested PCR amplification for the (7 of 13) and (11of 13) genes. Eleven patients had a definite diagnosis of endocarditis, which represents 9.8% of all endocarditis. Because endocarditis seems to be very common in Tunisia, we suggest that its serology be performed systematically whenever endocarditis is suspected.


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  1. Raoult D, Roux V, 1999. The body louse as a vector of reemerging human diseases. Clin Infect Dis 29 : 888–911.
  2. Ohl ME, Spach DH, 2000. Bartonella quintana and urban trench fever. Clin Infect Dis 31 : 131–135.
  3. Spach DH, Callis KP, Paauw DS, Houze YB, Schoenknecht FD, Welch DF, Rosen H, Brenner DJ, 1993. Endocarditis caused by Rochalimaea quintana in a patient infected with human immunodeficiency virus. J Clin Microbiol 31 : 692–694.
  4. Koehler JE, Quinn FD, Berger TG, Leboit PE, Tappero JW, 1992. Isolation of Rochalimaea species from cutaneous and osseous lesions of bacillary angiomatosis. N Engl J Med 327 : 1625–1631.
  5. Drancourt M, Mainardi JL, Brouqui P, Vandenesch F, Carta A, Lehnert F, Etienne J, Goldstein F, Acar J, Raoult D, 1995. Bartonella (Rochalimaea) quintana endocarditis in three homeless men. N Engl J Med 332 : 419–423.
  6. Spach DH, Kanter AS, Daniels NA, Nowowiejski DJ, Larson AM, Schmidt RA, Swaminathan B, Brenner DJ, 1995. Bartonella (Rochalimaea) species as a cause of apparent “culture-negative” endocarditis. Clin Infect Dis 20 : 1044–1047.
  7. Raoult D, Fournier PE, Drancourt M, Marrie TJ, Etienne J, Cosserat J, Cacoub P, Poinsignon Y, Leclercq P, Sefton AM, 1996. Diagnosis of 22 new cases of Bartonella endocarditis. Ann Intern Med 125 : 646–652.
  8. Fournier PE, Lelievre H, Eykyn SJ, Mainardi JL, Marrie TJ, Bruneel F, Roure C, Nash J, Clave D, James E, Benoit-Lemercier C, Deforges L, Tissot-Dupont H, Raoult D, 2001. Epidemiologic and clinical characteristics of Bartonella quintana and Bartonella henselae endocarditis: a study of 48 patients. Medicine (Baltimore) 80 : 245–251.
  9. Fournier PE, Mainardi JL, Raoult D, 2002. Value of Microimmunofluorescence for Diagnosis and Follow-up of Bartonella Endocarditis. Clin Diagn Lab Immunol 9 : 795–801.
  10. Rolain JM, Lecam C, Raoult D, 2003. Simplified serological diagnosis of endocarditis due to Coxiella burnetii and Bartonella. Clin Diag Lab Immunol 10 : 1147–1148.
  11. La Scola B, Raoult D, 1996. Serological cross reactions between Bartonella quintana, Bartonella henselae, and Coxiella burnetii. J Clin Microbiol 34 : 2270–2274.
  12. Houpikian P, Raoult D, 2003. Diagnostic methods. Current best practices and guidelines for identification of difficult-to-culture pathogens in infective endocarditis. Cardiol Clin 21 : 207–217.
  13. Maurin M, Eb F, Etienne J, Raoult D, 1997. Serological cross-reactions between Bartonella and Chlamydia species: Implications for diagnosis. J Clin Microbiol 35 : 2283–2287.
  14. Mann P, Nye F, Williams G, Walker A, Amadi A, 2003. From trench fever to endocarditis. Postgrad Med J 79 : 655–656.
  15. Gdoura R, Pereyre S, Frikha I, Hammami N, Clerc M, Sahnoun Y, Bebear C, Daoud M, de Barbeyrac B, Hammami A, 2002. Culture-negative endocarditis due to Chlamydia pneumoniae. J Clin Microbiol 40 : 718–720.
  16. Li JS, Sexton DJ, Mick N, Nettles R, Fowler VGJ, Ryan T, Bashore T, Corey GR, 2000. Proposed modifications to the duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis 30 : 633–638.
  17. Houpikian P, Raoult D, 2003. Western immunoblotting for Bartonella endocarditis. Clin Diagn Lab Immunol 10 : 95–102.
  18. Zeaiter Z, Fournier PE, Greub G, Raoult D, 2003. Diagnosis of Bartonella endocarditis by a real-time nested PCR assay using serum. J Clin Microbiol 41 : 919–925.
  19. Pitulle C, Strehse C, Brown JW, Breitschwerdt EB, 2002. Investigation of the phylogenetic relationships within the genus Bartonella based on comparative sequence analysis of the rnpB gene, 16S rDNA and 23S rDNA. Int J Syst Evol Microbiol 52 : 2075–2080.
  20. Park SY, Kelminson KL, Lee AK, Zhang P, Warner RE, Rehkopf DH, Calderwood SB, Koehler JE, 2001. Identification, characterization, and functional analysis of a gene encoding the ferric uptake regulation protein in Bartonella species. J Bacteriol 183 : 5751–5755.
  21. Tissot-Dupont H, Thirion X, Raoult D, 1994. Q fever serology: cutoff determination for microimmunofluorescence. Clin Diag Lab Immunol 1 : 189–196.
  22. Campbell LA, Kuo CC, Grayston JT, 1998. Chlamydia pneumoniae and cardiovascular disease. Emerg Infect Dis 4 : 571–579.
  23. Jacomo V, Kelly PJ, Raoult D, 2002. Natural History of Bartonella Infections (an Exception to Koch’s Postulate). Clin Diagn Lab Immunol 9 : 8–18.
  24. Rolain JM, Franc M, Davoust B, Raoult D, 2003. Molecular detection of Bartonella quintana, B. koehlerae, B. henselae, B. clarridgeiae, Rickettsia felis and Wolbachia pipientis in cat fleas, France. Emerg Infect Dis 9 : 338–342.
  25. Fichet-Calvet E, Jomaa I, Ben Ismail R, Ashford RW, 2000. Patterns of infection of haemoparasites in the fat sand rat, Psammomys obesus, in Tunisia, and effect on the host. Ann Trop Med Parasitol 94 : 55–68.
  26. Raoult D, Fournier PE, Vandenesch F, Mainardi JL, Eykyn SJ, Nash J, James E, Benoit-Lemercier C, Marrie TJ, 2003. Outcome and treatment of Bartonella endocarditis. Arch Intern Med 163 : 226–230.
  27. Rolain JM, Brouqui P, Koehler JE, Maguina C, Dolan MJ, Raoult D, 2004. Recommendations for treatment of human infections caused by Bartonella species. Antimicrob Agents Chemother 48 : 1921–1933.
  28. Millar B, Moore J, Mallon P, Xu J, Crowe M, Mcclurg R, Raoult D, Earle J, Hone R, Murphy P, 2001. Molecular diagnosis of infective endocarditis–a new Duke’s criterion. Scand J Infect Dis 33 : 673–680.
  29. Tariq M, Alam M, Munir G, Khan MA, Smego RA Jr, 2004. Infective endocarditis: a five-year experience at a tertiary care hospital in Pakistan. Int J Infect Dis 8 : 163–170.
  30. Brouqui P, Raoult D, 2001. Endocarditis due to rare and fastidious bacteria. Clin Microbiol Rev 14 : 177–207.
  31. Simon-Vermot I, Altwegg M, Zimmerli W, Flückiger U, 1999. Duke criteria-negative endocarditis caused by Bartonella quintana. Infection 27 : 283–285.
  32. Werner M, Fournier PE, Andersson R, Hogevik H, Raoult D, 2003. Bartonella and Coxiella antibodies in 334 prospectively studied episodes of infective endocarditis in Sweden. Scand J Infect Dis 35 : 724–727.
  33. Lamas CC, Eykyn SJ, 2003. Blood culture negative endocarditis: analysis of 63 cases presenting over 25 years. Heart 89 : 258–262.

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  • Received : 26 Aug 2004
  • Accepted : 06 Nov 2004

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