Chronic Q fever. Ninety-two cases from France, including 27 cases without endocarditis

Brouqui, Philippe; Dupont, Hervé; Drancourt, Michel; Berland, Yvon; Etienne, Jérôme; Leport, Catherine; Goldstein, F; Massip, P.; Micoud, M.; Bertrand, A; Raoult, Didier

doi:10.1001/archinte.153.5.642

Cited by 154 publications

(182 citation statements)

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“…In a cohort of 1569 patients from France diagnosed with acute Q fever, only 12 individuals developed endocarditis (17). Chronic infection occurs almost exclusively in two groups: those with pre-existing valvular heart disease and those who are immunocompromised (18,19). In one recent series, patients with a valvulopathy and acute Q fever had a 38.7% chance of going on to develop endocarditis (17).…”

Section: Discussionmentioning

confidence: 99%

“…Mild hepatitis is usually seen concurrently on biochemical analysis, with elevation of both aminotransferases and alkaline phosphatase. Furthermore, a systemic inflammatory syndrome is seen in most patients, manifested in part by a significantly elevated ESR (18). Many hematological abnormalities are also observed in up to 50% of cases, with the most frequent being anemia (5).…”

Section: Discussionmentioning

confidence: 99%

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Q fever endocarditis: A case report and review of the literature

Deyell

Chiu²,

Ross

et al. 2006

Canadian Journal of Cardiology

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E ndocarditis is the most common presentation of chronic Q fever, a zoonosis caused by the obligate intracellular bacteria Coxiella burnetii. Commonly believed to be a rare disorder, it has been estimated to account for up to 5% of all endocarditis cases worldwide (1-3). It occurs almost exclusively in patients who have pre-existing valvular disease or who are immunocompromised (4). Unlike typical cases of endocarditis, the clinical presentation of chronic Q fever is often nonspecific. Furthermore, specialized techniques are required for identification of the organism, and echocardiographic evidence of infection is frequently absent (5). Without prompt recognition and appropriate antimicrobial therapy, the course of Q fever endocarditis is severe and potentially fatal. The following case demonstrates many of the clinical features of chronic Q fever and highlights the difficulty of obtaining the diagnosis. CASE PRESENTATIONA 31-year-old Caucasian man presented to a walk-in clinic complaining of progressive, exertional shortness of breath. He had moved to Calgary, Alberta, from Nova Scotia, where he had worked on a dairy farm, two years prior. Due to pre-existing congenital valvular heart disease, he was referred to the Adult Congenital Cardiology Clinic at the University of Calgary (Calgary, Alberta). The patient could barely climb one flight of stairs without significant shortness of breath, and had developed orthopnea and paroxysmal nocturnal dyspnea. He described occasional palpitations, but denied any syncopal episodes, chest discomfort or peripheral edema. There were no symptoms suggestive of systemic infection.Of note, the patient had been diagnosed with congenital aortic stenosis at the age of eight months and underwent open aortic valvulotomy. The patient was found to have a trileaflet valve with significant fusion of the leaflets. Catheterization at the age of 10 years revealed a peak residual gradient of 25 mmHg across the aortic valve with mild aortic insufficiency. Echocardiograms at the ages of 18 and 22 years demonstrated peak gradients of 37 mmHg and 56 mmHg, respectively, moderate aortic insufficiency and preserved left ventricular function. The patient had no cardiology follow-up after the age of 22 years.Physical examination revealed a blood pressure of 110/50 mmHg, a heart rate of 82 beats/min and a normal The case of a 31-year-old man from Alberta diagnosed with Q fever endocarditis is presented. To the authors' knowledge, this is the first case of Q fever endocarditis diagnosed in the province of Alberta. The patient had undergone open valvulotomy for congenital aortic stenosis as an infant. He presented with congestive heart failure secondary to severe aortic regurgitation and underwent mechanical aortic valve replacement. Early failure of the mechanical prosthesis and numerous laboratory abnormalities prompted an investigation for endocarditis, which was initially negative. Markedly positive serology eventually established the diagnosis of chronic Q fever. The patient subsequently underwent...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Q fever endocarditis: A case report and review of the literature

Deyell

Chiu²,

Ross

et al. 2006

Canadian Journal of Cardiology

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“…The most common clinical presentation of acute Q fever in human is an influenza-like illness, often accompanied by pneumonia. The chronic Q fever form, particularly endocarditis, may appear several years after the primary episode (1,2,6,21). Because the clinical presentation of the infection is not specific, serological confirmation is required for the diagnosis of Q fever.…”

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confidence: 99%

New Criteria for Immunofluorescence Assay for Q Fever Diagnosis in Japan

Setiyono

Ogawa²,

Cai³

et al. 2005

J Clin Microbiol

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A study was made to evaluate the cutoff value of indirect immunofluorescent-antibody (IFA) test for Q fever diagnosis in Japan. We used 346 sera, including 16 from confirmed Q fever cases, 304 from Japanese pneumonia patients, and 26 from negative cases. Thirteen sera from the confirmed Q fever cases with an immunoglobulin M (IgM) titer of >1:128 and/or IgG titer of >1:256 by the IFA test were positive by both enzyme-linked immunosorbent assay (ELISA) and Western blotting assay (WBA), whereas 298 sera from pneumonia patients and 26 negative sera with an IgM titer of <1:16 and an IgG titer of <1:32 by the IFA test were negative by both ELISA and WBA. In the proposed "equivocal area," with an IgM titer of >1:32 and <1:64 and/or an IgG titer of >1:64 and <1:128, we found 9 sera, 3 from confirmed Q fever cases and 6 from Japanese pneumonia patients, by the IFA test. Three sera from the confirmed Q fever cases and one of the sera from pneumonia patients were IgM and/or IgG positive by both ELISA and WBA. These results suggest that a single cutoff value for the IFA test may cause false-positive and false-negative results. In conclusion, this study showed that an "equivocal area" should be used for the IFA test rather than a single cutoff value and that sera in the equivocal area should be tested by additional serological assays for confirmation.

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“…Chronic disease can be life threatening and most often presents as endocarditis or hepatitis (13). Even with antimicrobial intervention, mortality rates have been reported to be as high as 24% (2). The most effective treatment of chronic Q fever includes a combination of doxycycline and chloroquine administered for at least 18 months (13).…”

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confidence: 99%

Evaluation of Coxiella burnetii Antibiotic Susceptibilities by Real-Time PCR Assay

2003

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Coxiella burnetii is an obligate intracellular bacterium. The inability to cultivate this organism on axenic medium has made calculation of infectious units challenging and prevents the use of conventional antibiotic susceptibility assays. A rapid and reliable real-time PCR assay was developed to quantify C. burnetii cells from J774.16 mouse macrophage cells and was applied to antibiotic susceptibility testing of C. burnetii Nine Mile, phase I. For calculation of bacterial replication, real-time PCR performed equally as well as immunofluorescent-antibody (IFA) assay when J774.16 cells were infected with 10-fold serial dilutions of C. burnetii and was significantly (P < 0.05) more repeatable than IFA when 2-fold dilutions were used. Newly infected murine macrophage-like J774.16 cells were treated with 8 g of chloramphenicol per ml, 4 g of tetracycline per ml, 4 g of rifampin per ml, 4 g of ampicillin per ml, or 1 g of ciprofloxacin per ml. After 6 days of treatment, tetracycline, rifampin, and ampicillin significantly (P < 0.01) inhibited the replication of C. burnetii, while chloramphenicol and ciprofloxacin did not. In general, these results are consistent with those from prior reports on the efficacy of these antibiotics against C. burnetii Nine Mile, phase I, and indicate that a real-time PCR-based assay is an appropriate alternative to the present methodology for evaluation of the antibiotic susceptibilities of C. burnetii.

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Chronic Q fever. Ninety-two cases from France, including 27 cases without endocarditis

Abstract: In patients with unexplained fever, negative blood cultures, and a history of underlying vascular or cardiac disease, Q fever should be considered.

Cited by 154 publications

References 35 publications

Q fever endocarditis: A case report and review of the literature

Q fever endocarditis: A case report and review of the literature

New Criteria for Immunofluorescence Assay for Q Fever Diagnosis in Japan

Evaluation of Coxiella burnetii Antibiotic Susceptibilities by Real-Time PCR Assay

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