Coxiella burnetii infection of aortic aneurysms or vascular grafts: report of 30 new cases and evaluation of outcome

Abstract

Q fever is a zoonotic disease caused by Coxiella burnetii. Polymorphic, the disease may present as an acute or chronic infection. Vascular infections are the second most common form of chronic Q fever, following endocarditis. Herein, we studied the outcome of 30 new cases of aortic infection caused by C. burnetii using uni- and multivariate analyses. The outcome of ten cases previously reported by our team was also updated. Of these 40 patients, 32 had a follow-up of >or=3 years. Among them, the overall mortality was of 25% (8/32). Vascular rupture was significantly and independently (multivariate P=0.03) associated with a lethal issue, whereas vascular surgery was significantly associated with recovery (uni- and multivariate P<0.01). Our findings demonstrate the critical importance of surgery in the management of C. burnetii vascular infections.

Chronic Q Fever in the Netherlands 5 Years after the Start of the Q Fever Epidemic: Results from the Dutch Chronic Q Fever Database

“…When only patients with chronic Q fever-related mortality were analyzed, the mortality rate among patients with proven and probable chronic Q fever was 13.0%, with a 9.3% mortality rate among endocarditis patients and 18.0% in vascular chronic Q fever cases. These figures confirm the results of previous studies showing differences in mortality rates of both disease entities (9,13,14). Most patients died due to vascular complications of vascular chronic Q fever.…”

“…The most common manifestations are endocarditis, which according to the literature accounts for approximately 75% of all chronic Q fever cases, and vascular chronic Q fever, consisting of infections of vascular prostheses and aortic aneurysms (1,(7)(8)(9). Less common manifestations are osteomyelitis, pericarditis, and hepatitis (8).…”

“…Less common manifestations are osteomyelitis, pericarditis, and hepatitis (8). Important risk factors are heart valve pathology, especially valve prostheses, vascular prostheses, and aneurysms (9)(10)(11)(12). Immunosuppression also seems to be associated with an elevated risk, as well as older age, pregnancy, and (mild) renal insufficiency (3,11,12).…”

“…Immunosuppression also seems to be associated with an elevated risk, as well as older age, pregnancy, and (mild) renal insufficiency (3,11,12). Before severe complications occur, most patients are asymptomatic or report only nonspecific symptoms such as low-grade fever, night sweats, and weight loss (1,6,9,13). In case of endocarditis, findings on echocardiography are often nonspecific or absent (13).…”

“…An early diagnosis of chronic Q fever has major clinical implications, as chronic Q fever causes high morbidity and a mortality rate of up to 60% when left untreated (1,13). Long-term antibiotic treatment, consisting of doxycycline and hydroxychloroquine, and resection of infected vascular and valvular tissue are thought to improve prognosis (9,13,14).…”