Chronic Q fever: A missed prosthetic valve endocarditis possibly for years

Abstract

Chronic Coxiella burnetii endocarditis usually develops in people with underlying heart disease and accounts for 60–70% of chronic Q fever. Onset is generally insidious and manifestations are atypical. The authors report a case of Coxiella burnetii prosthetic valve endocarditis in a 53 years- old patient with recurrent mechanical valve dehiscence on mitral position. He lived in a rural area with sheep and goats on the surroundings. During a 9 year- period, he was submitted to three cardiac mitral valve surgeries two of which with no Q fever diagnosis suspicion. Diagnosis was based on a positive serology test (Indirect imunofluorescence). Treatment consisted in a combination of prolonged course of hydroxychloroquine plus doxycycline and surgical replacement of the mitral valve, with a favorable outcome. With this case report, the authors pretend to highlight the not always expected diagnosis of Q fever endocarditis. If not considered, Coxiella burnetii endocarditis may lead to multiple cardiac surgeries, greater morbidity and potentially death.

Missed aortic valve endocarditis resulting in complete atrioventricular block and redo aortic valve replacement

“…After the third episode requiring surgical intervention, serology revealed a Coxiella burnetii infection, which had persisted as chronic Q fever for years. The present case and the report of Ferraz et al (8) both highlights that culture-negative endocarditis can be particularly challenging to diagnose and therefore treatment should not be delayed while awaiting culture results. Since culture-negative endocarditis is known to occur in up to 31% of cases (9), it is of paramount consider this as a differential diagnosis especially in patients with prosthetic valve replacement presenting with the non-specific symptoms suggestive of infection.…”

“…There are very few previous reports on missed endocarditis following surgical valve replacements. Ferraz et al (8) described a case of culture-negative endocarditis resulting in recurrent mechanical valve dehiscence in the mitral position. After the third episode requiring surgical intervention, serology revealed a Coxiella burnetii infection, which had persisted as chronic Q fever for years.…”

Missed aortic valve endocarditis resulting in complete atrioventricular block and redo mechanical valve replacement

“…After the third episode requiring surgical intervention, serology revealed a Coxiella burnetii infection, which had persisted as chronic Q fever for years. The present case and the report of Ferraz et al 8 both highlight that culture-negative endocarditis can be particularly challenging to diagnose and therefore treatment should not be delayed while awaiting culture results. As culture-negative endocarditis is known to occur in up to 31% of cases,9 it is of paramount to consider this as a differential diagnosis especially in patients with prosthetic valve replacement presenting with the non-specific symptoms suggestive of infection.…”

“…Ferraz et al 8 described a case of culture-negative endocarditis resulting in recurrent mechanical valve dehiscence in the mitral position. After the third episode requiring surgical intervention, serology revealed a Coxiella burnetii infection, which had persisted as chronic Q fever for years.…”

Case report: a missed case of chronic Q fever infective endocarditis demonstrating the ongoing diagnostic challenges

“…The diagnosis of chronic Q fever can be challenging due to its protean manifestations and indirect diagnosis using serology [12]. Further, despite endocarditis being a common clinical manifestation, the infection itself is still rare, making it easy to overlook [13]. A previous case series has described patients presenting with endocarditis caused by C. burnetti and also another concomitant bacterial pathogen [14,15].…”