**6. Conclusions**

In the last years and with the development of molecular tools, new cases of *T. whipplei* endocarditis have been diagnosed. For this reason, although *T. whipplei* infective endocarditis is an infrequent condition has emerged as an important differential diagnosis for BCNE. Endocarditis due to *T. whipplei* is often slowly progressive, similar to that caused by *Coxiella burnetii* and *Bartonella* spp. and it could be diagnosed with specific procedures when BCNE undergo cardiac surgery. An early and appropriate diagnosis is required since this condition has a very good course and prognosis when the appropriate treatment is started (including surgery). In our opinion, patients with unexplained valve destruction which requires cardiac surgery, an exhaustive clinical investigation must be performed and removed valves should be studied by molecular tools for to rule out an underlying infectious endocarditis.
