Estimated prevalence of chronic Q fever among Coxiella burnetii seropositive patients with an abdominal aortic/iliac aneurysm or aorto-iliac reconstruction after a large Dutch Q fever outbreak

Hagenaars, Julia C.J.P.; Wever, Peter C.; Petersen, André S. van; Lestrade, P; Jager-Leclercq, Monique G.L. de; Hermans, Mirjam H. A.; Moll, Frans L.; Koning, Olivier H.J.; Renders, Nicole H. M.

doi:10.1016/j.jinf.2014.03.009

Cited by 32 publications

(45 citation statements)

References 27 publications

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“…In the Netherlands, a country that faced a significant Q fever outbreak between 2007 and 2010, recent work in 1 center over a 3-year period reports a seroprevalence of Q fever of 13.6 % among 149 patients with a vascular graft, of whom 25% (5 patients) had a serologic profile compatible with a vascular infection. 7 Such studies in other European countries would be useful to better estimate the global prevalence of the disease to propose accurate treatment.…”

Section: Discussionmentioning

confidence: 99%

Treatment and Prophylactic Strategy for Coxiella burnetii Infection of Aneurysms and Vascular Grafts

et al. 2016

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Coxiella burnetii vascular infections continue to be very severe diseases and no guidelines exist about their prevention. In terms of treatment, the benefit of the surgical removal of infected tissues has been suggested by 1 retrospective study.We present a case of a C burnetii abdominal aortic graft infection for which we observed a dramatic clinical and biological recovery after surgery. We thus performed a retrospective cohort study to evaluate the impact of surgery on survival and serological outcome for patients with Q fever vascular infections diagnosed in our center.Between 1986 and February 2015, 100 patients were diagnosed with Q fever vascular infections. The incidence of these infections has significantly increased over the past 5 years, in comparison with the mean annual incidence over the preceding 22 years (8.83 cases per year versus 3.14 cases per year, P = .001). A two-and-a-half-year follow-up was available for 66 patients, of whom 18.2% died. We observed 6.5% of deaths in the group of patients who were operated upon at 2 and a half years, in comparison with 28.6% in the group which were not operated upon (P = .02). Surgery was the only factor that had a positive impact on survival at 2 and a half years using univariate analysis [hazard ratio: 0.17 [95% CI]: [0.039–0.79]; P = .024]. Surgery was also associated with a good serological outcome (74.1% vs 57.1% of patients, P = .03). In the group of patients with vascular graft infections (n = 47), surgery had a positive impact on serological outcome at 2 and a half years (85.7% vs 42.9%, P < .001) [hazard ratio: 0.40 [95% CI]: [0.17–098]; P = .046] and tended to be associated with lower although not statistically significant mortality (11.1% vs 27.6% of deaths, P = .19).Surgical treatment confers a benefit in terms of survival following C burnetii vascular infections. However, given the high mortality of these infections and their rising incidence, we propose a strategy that consists of screening for vascular graft and aneurysms in the context of primary Q fever, to decide when to start prophylactic treatment, similar to the strategy recommended for the prophylaxis of Q fever endocarditis.

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Section: Discussionmentioning

confidence: 99%

Treatment and Prophylactic Strategy for Coxiella burnetii Infection of Aneurysms and Vascular Grafts

et al. 2016

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“…Individuals with heart valve defects, aneurysms, or vascular prostheses are susceptible to develop a persistent infection (4). During the major Q fever epidemic in the Netherlands, approximately 30% of individuals with known aorto-iliac disease and serological evidence of Q fever infection developed chronic Q fever (5). Therefore, an additional risk factor resulting in a defective systemic or local immune response is likely to be required for the development of chronic Q fever.…”

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Viable Coxiella burnetii Induces Differential Cytokine Responses in Chronic Q Fever Patients Compared to Heat-Killed Coxiella burnetii

Jansen¹,

Dinkla

Roest

et al. 2018

Infect Immun

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Cytokine responses of chronic Q fever patients to the intracellular bacterium have mostly been studied using stimulation of immune cells with heat-killed due to the extensive measures needed to work with viable biosafety level 3 agents. Whether research with heat-killed can be translated to immune responses to viable is imperative for the interpretation of previous and future studies with heat-killed Peripheral blood mononuclear cells (PBMCs) of chronic Q fever patients ( = 10) and healthy controls ( = 10) were stimulated with heat-killed or viable of two strains, Nine Mile and the Dutch outbreak strain 3262, for 24 h, 48 h, and 7 days in the absence or presence of serum containing anti- antibodies. When stimulated with viable , PBMCs of chronic Q fever patients and controls produced fewer proinflammatory cytokines (interleukin-6 [IL-6], tumor necrosis factor alpha, and IL-1β) after 24 h than after stimulation with heat-killed In the presence of Q fever seronegative serum, IL-10 production was higher after stimulation with viable rather than heat-killed ; however, when incubating with anti- antibody serum, the effect on IL-10 production was reduced. Levels of adaptive, merely T-cell-derived cytokine (gamma interferon, IL-17, and IL-22) and CXCL9 production were not different between heat-killed and viable stimulatory conditions. Results from previous and future research with heat-killed should be interpreted with caution for innate cytokines, but heat-killed -induced adaptive cytokine production is representative of stimulation with viable bacteria.

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“…In the Dutch cohort, after primary infection, progression to vascular chronic Q fever in patients with an abdominal aortic aneurysm was high, 30.8% compared with 7.8% progression to Q fever endocarditis in patients with a history of cardiac valve surgery (Kampschreur et al . b; Hagenaars ). Patients with vascular chronic Q fever can present with a life‐threatening acute complication, such as a symptomatic aneurysm, ruptured aneurysm, mycotic aneurysm, aorto‐duodenal fistula or aorto‐caval fistula.…”

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Histological characteristics of the abdominal aortic wall in patients with vascular chronic Q fever

Hagenaars

Koning

Haak

et al. 2014

Int J Experimental Path

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The aim of this study was to describe specific histological findings of the Coxiella burnetii-infected aneurysmal abdominal aortic wall. Tissue samples of the aneurysmal abdominal aortic wall from seven patients with chronic Q fever and 15 patients without evidence of Q fever infection were analysed and compared. Chronic Q fever was diagnosed using serology and tissue PCR analysis. Histological sections were stained using haematoxylin and eosin staining, Elastica van Gieson staining and immunohistochemical staining for macrophages (CD68), T lymphocytes (CD3), T lymphocyte subsets (CD4 and CD8) and B lymphocytes (CD20). Samples were scored by one pathologist, blinded for Q fever status, using a standard score form. Seven tissue samples from patients with chronic Q fever and 15 tissue samples from patients without Q fever were collected. Four of seven chronic Q fever samples showed a necrotizing granulomatous response of the vascular wall, which was characterized by necrotic core of the arteriosclerotic plaque (P = 0.005) and a presence of high numbers of macrophages in the adventitia (P = 0.007) distributed in typical palisading formation (P = 0.005) and surrounded by the presence of high numbers of T lymphocytes located diffusely in media and adventitia. Necrotizing granulomas are a histological finding in the C. burnetii-infected aneurysmal abdominal aortic wall. Chronic Q fever should be included in the list of infectious diseases with necrotizing granulomatous response, such as tuberculosis, cat scratch disease and syphilis.

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Estimated prevalence of chronic Q fever among Coxiella burnetii seropositive patients with an abdominal aortic/iliac aneurysm or aorto-iliac reconstruction after a large Dutch Q fever outbreak

Cited by 32 publications

References 27 publications

Treatment and Prophylactic Strategy for Coxiella burnetii Infection of Aneurysms and Vascular Grafts

Treatment and Prophylactic Strategy for Coxiella burnetii Infection of Aneurysms and Vascular Grafts

Viable Coxiella burnetii Induces Differential Cytokine Responses in Chronic Q Fever Patients Compared to Heat-Killed Coxiella burnetii

Histological characteristics of the abdominal aortic wall in patients with vascular chronic Q fever

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