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A 58-year-old sheep farmer with a bioprosthetic aortic valve has had low-grade fevers, night sweats and weight loss for 4 months. Echocardiography shows a small vegetation on the valve. He took no antibiotics before three blood culture sets were drawn from separate sites, and all three are negative after 5 days in a continuous-monitoring system. Further results: Bartonella IgG negative; Brucella antibody negative; Coxiella burnetii IgG by immunofluorescence, phase I 1:4,096 and phase II 1:1,024. Which diagnosis best fits these results?
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