Q Fever Endocarditis in the South of France

Raoult, Didier; Etienne, Jérôme; Massip, P.; Iaocono, S.; Prince, Mateus Augusto de; Beaurain, Patrick; Benichou, S.; Auvergnat, J.Ch.; Mathieu, P; Bachet, P.; Serradimigni, A

doi:10.1093/infdis/155.3.570

Cited by 82 publications

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“…In contrast, the Priscilla isolate, implicated as a cause of chronic Q fever in goats (21)-and possibly humans-exhibited significant resistance to all antibiotics that were effective against the Nine Mile isolate. This observation is in agreement with the fact that chronic Q fever in humans, including Q-fever endocarditis, is not successfully managed with either antibiotic treatment or a combination of antibiotic treatment and surgical procedures (7,18,22,24,26,27).…”

Section: Methodssupporting

confidence: 85%

“…The use of antibiotics in treating patients with Q-fever endocarditis has been relatively unsuccessful (7,18,22,24,26,27 …”

Section: Methodsmentioning

confidence: 99%

“…Antibiotic management of acute Q fever is generally successful in noncompromised patients, whereas antibiotic management of chronic Q-fever endocarditis or hepatitis is poor at best (7,11,18,22,23,25,27). In light of these observations, we have previously demonstrated that rifampin and several 4-quinolone antibiotics (ciprofloxacin, difloxacin, and oxolinic acid) are highly effective in reducing persistent in vitro infections caused by Nine Mile C. burnetii (28).…”

mentioning

confidence: 99%

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Antibiotic susceptibilities of two Coxiella burnetii isolates implicated in distinct clinical syndromes

Yeaman

Roman

Baca

1989

Antimicrob Agents Chemother

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Antibiotic susceptibility testing of two isolates of the Q-fever agent, Coxiella burnetii, was performed with recently and persistently infected L929 fibroblast cells. The two genetically distinct isolates, Nine Mile and Priscilla, are implicated in two different clinical disease syndromes, acute and chronic Q fever, respectively. We compared the efficacies of rifampin, doxycycline, and five 4-quinolone compounds (ciprofloxacin, difloxacin, ofloxacin, norfloxacin, and pefloxacin) in reducing persistent C. burnetii infection of L929 fibroblasts. In persistently infected cells, the Priscilla isolate was less susceptible to all antibiotics tested when compared with the Nine Mile isolate. The most effective antibiotics against the Priscilla isolate were ofloxacin, pefloxacin, and ciprofloxacin (50% inhibitory concentrations of 0.5, 2.2, and 2.5 micrograms/ml, respectively). In persistently infected cells, the Nine Mile isolate was highly susceptible to all antibiotics tested except doxycycline. In contrast, the Priscilla and Nine Mile isolates in recently infected cells were somewhat susceptible to doxycycline; the Priscilla isolate was significantly more susceptible to ofloxacin and rifampin in recently infected host cells than in persistently infected cells. Persistently infected L929 cells were also treated with antibiotic combinations. Although ciprofloxacin and doxycycline had no synergistic effect on the Priscilla isolate, ciprofloxacin and rifampin acted synergistically. Collectively, these in vitro results are in accord with the fact that chronic Q fever in humans is generally not successfully managed with antibiotics. They also indicate that early diagnosis may be essential and that combination antibiotic therapy that includes quinolones may be effective in treating chronic Q fever.

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Section: Methodssupporting

confidence: 85%

“…The use of antibiotics in treating patients with Q-fever endocarditis has been relatively unsuccessful (7,18,22,24,26,27 …”

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Antibiotic susceptibilities of two Coxiella burnetii isolates implicated in distinct clinical syndromes

Yeaman

Roman

Baca

1989

Antimicrob Agents Chemother

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“…Over 90% of Q fever endocarditis cases occur in persons with underlying heart disease, which may be congenital, rheumatic, degenerative, or syphilitic or may involve prosthetic valves (23). Whereas C. burnetii accounts for 3% of all endocarditis cases diagnosed in England and Wales (26) and at least 5% of cases in France (29), there have been only seven reported cases of Q fever endocarditis in the United States, including the patient presented here (1,4,10,13,27). However, the true number of chronic Q fever cases in the United States is unknown and is likely underrepresented in the literature, since many cases may have occurred prior to the advent of national reporting in 1999.…”

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confidence: 99%

Chronic Q Fever in the United States

Karakousis¹,

Trucksis

Dumler

2006

J Clin Microbiol

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Infections due to Coxiella burnetii, the causative agent of Q fever, are uncommon in the United States. Cases of chronic Q fever are extremely rare and most often manifest as culture-negative endocarditis in patients with underlying valvular heart disease. We describe a 31-year-old farmer from West Virginia with a history of congenital heart disease and recurrent fevers for 14 months who was diagnosed with Q fever endocarditis based on an extremely high antibody titer against Coxiella burnetii phase I antigen. Despite treatment with doxycycline, he continued to have markedly elevated Coxiella burnetii phase I antibody titers for 10 years after the initial diagnosis. To our knowledge, this case represents the longest follow-up period for a patient with chronic Q fever in the United States. We review all cases of chronic Q fever reported in the United States and discuss important issues pertaining to epidemiology, diagnosis, and management of this disease. CASE REPORTA 31-year-old farmer from West Virginia was admitted in June 1995 because of recurrent episodes of fever as high as 39°C, night sweats, paroxysmal coughing, chest pressure, decreased appetite, fatigue, and an 11-kg involuntary weight loss over the preceding 14 months. He had been treated several times for presumed bronchitis with various antibiotics, but his complaints had worsened since December 1994. His past medical history was significant for congenital heart disease, including dextrocardia, a double-outlet right ventricle, a ventricular septal defect, and severe pulmonary stenosis. As an infant, he had undergone operative placement of a right Blalock-Taussig shunt, and at age 12, he underwent surgery for closure of a ventricular septal defect and placement of a conduit between the right ventricle and pulmonary artery. At age 26, he underwent surgery for replacement with a 22-mm Hancock conduit. He participated in birthing his calves, one of which was stillborn around the time of the onset of his illness. He was treated empirically with penicillin, gentamicin, and vancomycin, and his fevers resolved.On physical examination, he was a thin, chronically ill-appearing white male. His vital signs were within normal limits, and he was afebrile. Cardiac examination revealed a grade 3/6 harsh systolic ejection murmur heard maximally at the right upper sternal border without radiation. The chest examination was normal. There was no hepatosplenomegaly, enlarged lymph nodes, or peripheral stigmata of endocarditis. Laboratory studies revealed the following results: hematocrit level was 41%; white blood cell count was 7.3 ϫ 10 9 white blood cells/ liter, with a differential cell count of 35% segmented neutrophils, 5% bands, and 54% lymphocytes; platelets were aggregated and uncountable; electrolyte panel and urinalysis were normal; erythrocyte sedimentation rate was 34 mm/h; and alkaline phosphatase, aspartate aminotransferase, and alanine aminotransferase levels were elevated at 198 U/liter, 244 U/ liter, and 196 U/liter, respectively. Serologies for hepatiti...

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“…The disease is, as a rule, an acute self-limiting illness which is characterized by the sudden onset of fever, headache, and pneumonitis and which responds to tetracycline therapy. However, chronic infections have been clearly documented (10,18). Q fever endocarditis is the most frequently lethal complication of C. burnetii infection (15,26).…”

mentioning

confidence: 99%

Comparison of different antibiotic regimens for therapy of 32 cases of Q fever endocarditis

Lévy¹,

Drancourt²,

Etienne³

et al. 1991

Antimicrob Agents Chemother

112

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We studied 32 cases of Q fever endocarditis diagnosed in France between January 1985 and December 1989 to evaluate the efficacies of the different regimens of antibiotics used for treatment. Each patient was monitored during the treatment (range, 12 to 60 months), and clinical and biological information was computerized. Various treatments were prescribed, including doxycycline alone (9 cases) or in association with rifampin (4 cases), quinolones (16 cases), or sulfamethoxazole-trimethoprim (1 case). Two patients died before the beginning of the treatment. Nineteen patients had hemodynamic failure and subsequently underwent valve replacement. Nine valve tissue cultures were positive despite previous antibiotic treatment. In terms of their effects on mortality, the difference between doxycycline alone and doxycycline plus quinolones is statistically significant. We conclude that the addition of quinolones to doxycycline is beneficial. On the basis of clinical, serological, and valve tissue culture results, no treatment was able to cure Q fever endocarditis within 2 years, even with a combination of antibiotics. We advise a minimum duration of treatment of 3 years with therapy combining quinolones and doxycycline.

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Q Fever Endocarditis in the South of France

Cited by 82 publications

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Antibiotic susceptibilities of two Coxiella burnetii isolates implicated in distinct clinical syndromes

Antibiotic susceptibilities of two Coxiella burnetii isolates implicated in distinct clinical syndromes

Chronic Q Fever in the United States

Comparison of different antibiotic regimens for therapy of 32 cases of Q fever endocarditis

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