ObjectiveNon-bacterial thrombotic endocarditis (NBTE) is a syndrome characterised by cardiac valve vegetations and/or thickening due to non-infective mechanisms. Nowadays, a premortem diagnosis of NBTE is possible based on echocardiographic findings. Therefore, to better characterise this disease, we performed a contemporary review of the epidemiology, demographics, diagnosis and clinical outcomes of these patients.MethodsAdults with a diagnosis of NBTE seen within the Mayo Clinic Enterprise from December 2014 to December 2021 were included. NBTE diagnosis was identified by clinicians representing at least two specialties including cardiology, infectious diseases, rheumatology and oncology. Patients with positive blood cultures, infective endocarditis, culture-negative endocarditis and denial of research authorisation were excluded. All patients had a 1-year follow-up.ResultsForty-eight cases were identified; mean age was 60.0±13.8 years, 75% were female. The most prevalent comorbidities were malignancy (52.1%) and connective tissue disease (37.5%). Valvular abnormalities included 41 (85.4%) patients with vegetations, 43 (89.6%) patients with thickening and 26 (54.2%) with moderate to severe regurgitation. Thirty-eight (79.2%) patients had an embolic event (stroke in 26 (54.2%) patients) within 1 month of NBTE diagnosis and 16 (33.3%) patients died within 1 year of NBTE diagnosis. Metastatic tumours and lung cancer were associated with 1-year all-cause mortality (p=0.0017 and p=0.0004, respectively).ConclusionsNBTE was more prevalent in females and embolic complications were the most frequent clinical finding. Overall, patients with NBTE had a poor prognosis, particularly in those with lung cancer or metastatic tumours. Further studies in patients with NBTE are needed given its morbidity and mortality.

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Background Diagnosing acute Q fever is challenging partly due to the non-specific and self-limited course of illness in the majority of cases. It is important to identify and treat patients who are at increased risk for progression to persistent disease to prevent future complications. We describe the demographics, clinical presentation, and treatment of patients diagnosed with acute Q fever at our institution. Methods We identified all patients diagnosed with acute Q fever between December 2019 and March 2022. Patients 18 years or older who had a Q fever anti-phase II IgM ≥ 1:50 and anti-phase II IgG ≥ 200 were included. Patient with an anti-phase II IgG < 200 were included if they had a fourfold rise in titers at follow-up within 3-6 weeks. Results Overall, 13 cases of acute Q fever were identified. Ages ranged between 32 and 68 years and 85% were men. The majority resided in the Midwest. A non-specific febrile illness was the most common presentation (11/13) (Table 1). Duration of symptoms predominantly ranged between 10 to 20 days. Elevated liver enzymes were noted in 7/13. Three had detectable Coxiella DNA in the blood during the acute phase using cell free DNA next generation sequencing but not using Coxiella PCR. Eleven patients had an exposure history. Overall, 6 patients received doxycycline monotherapy for a median of 14 days, while 7, who had risk factors for progression to chronic disease, received doxycycline and hydroxychloroquine for a median of 15 months. Among patients who followed-up, only one was restarted on therapy due to recurrence of symptoms. None of the patients developed infective endocarditis. Conclusion Acute Q fever is more frequently recognized, partly, because of increased awareness among physicians, however also possibly due to the increasing prevalence of the infection. In a cohort of 49 patients with Q fever at our institution between 2012 and 2018, 20 had acute Q fever, compared to 13 patients in this cohort. The infection predominantly affects men and the majority have an identifiable exposure history. Elevated CRP, abnormal liver enzymes, and detectable antiphospholipid antibodies were prevalent in our cohort. Patient with risk factors for progression into chronic disease were often placed on a longer course of a combination therapy in attempt to prevent chronic focal infections. Disclosures All Authors: No reported disclosures.