‘Chronic Q fever-related complications and mortality: data from a nationwide cohort’ – Author’s reply

Roeden, Sonja E van; Wever, Peter C.; Oosterheert, Jan Jelrik

doi:10.1016/j.cmi.2019.03.004

Cited by 8 publications

(7 citation statements)

References 5 publications

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“…A previous retrospective review of 439 patients with chronic Q fever in the Netherlands found that the mortality rate was as high as 38 % for cases of proven Q fever [16]. Mortality was higher in patients who had developed complications; the highest fatality rates were seen amongst patients with both a vascular and an endocarditis focus (33 %) [16]. Q fever infective endocarditis has high rates of relapse after antimicrobial cessation and requires a longer duration of treatment when a prosthetic valve is involved [17].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Case report: a missed case of chronic Q fever infective endocarditis demonstrating the ongoing diagnostic challenges

Grey,

Simos,

Runnegar

et al. 2023

Access Microbiology

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Diagnosis of chronic Q fever is often difficult for clinicians, particularly in the presence of a second pathology. In addition to the chronic constitutional symptoms, the most common manifestations of chronic Q fever include infective endocarditis and endovascular infection. We describe a case of prosthetic valve infective endocarditis caused by both Streptococcus sanguinis and Coxiella burnetti on a background of a previous aortic graft and bioprosthetic aortic valve replacement 2 years earlier. The diagnosis of chronic Q fever infective endocarditis was delayed because the significance of the abnormal valve histology from the patient’s previous surgery was initially overlooked. It was only after the patient had relapsed on appropriate therapy for the S. sanguinis prosthetic valve endocarditis that a subsequent review of the operative valve histology, along with the patient’s epidemiological risk factors, led to consideration of an additional culture-negative cause for infective endocarditis. Histological examination of the valve tissue had shown exophytic fibrin vegetations and acute inflammation. Further clinical assessment revealed previous exposure to Q fever and C. burnetti DNA was detected via polymerase chain reaction on the valve tissue. Q fever infective endocarditis must be considered if valves are inflamed or have vegetations with a subsequent negative culture. It should also still be considered in the presence of an alternative bacteraemia if the patient has risk factors for exposure.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Case report: a missed case of chronic Q fever infective endocarditis demonstrating the ongoing diagnostic challenges

Grey,

Simos,

Runnegar

et al. 2023

Access Microbiology

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“…Also, the study from Million et al suffers from potential survival bias, because it was performed in a tertiary referral centre. Patients that died early in the course of the disease would not have been referred [17,18].…”

Section: Discussionmentioning

confidence: 99%

The prognostic value of serological titres for clinical outcomes during treatment and follow-up of patients with chronic Q fever

Buijs

Roeden

Werkhoven

et al. 2021

Clinical Microbiology and Infection

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Objectives: We assessed the prognostic value of phase I IgG titres during treatment and follow-up of chronic Q fever. Methods: We performed a retrospective cohort study to analyse the course of phase I IgG titres in chronic Q fever. We used a multivariable time-varying Cox regression to assess our primary (first disease-related event) and secondary (therapy failure) outcomes. In a second analysis, we evaluated serological characteristics after 1 year of therapy (fourfold decrease in phase I IgG titre, absence of phase II IgM and reaching phase I IgG titre of 1:1024) with multivariable Cox regression. Results: In total, 337 patients that were treated for proven (n ¼ 284, 84.3%) or probable (n ¼ 53, 15.7%) chronic Q fever were included. Complications occurred in 190 (56.4%), disease-related mortality in 71 (21.1%) and therapy failure in 142 (42.1%) patients. The course of phase I IgG titres was not associated with first disease-related event (HR 1.00, 95% CI 0.86e1.15) or therapy failure (HR 1.02, 95% CI 0.91e1.15). Similar results were found for the serological characteristics for the primary (HR 0.97, 95% CI 0.62e1.51; HR 1.12, 95% CI 0.66e1.90; HR 0.99, 95% CI 0.57e1.69, respectively) and secondary outcomes (HR 0.86, 95% CI 0.57e1.29; HR 1.37, 95% CI 0.86e2.18; HR 0.80, 95% CI 0.48e1.34, respectively). Discussion: Coxiella burnetii serology does not reliably predict disease-related events or therapy failure during treatment and follow-up of chronic Q fever. Alternative markers for disease management are needed, but, for now, management should be based on clinical factors, PCR results, and imaging results.

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“…Bei etwa 1–5 % der Patienten kommt es zu einem chronischen Q‑Fieber. Hierbei können u. a. eine Entzündung des Herzens (Endokarditis), infizierte Aneurysmen oder infizierte Gefäßprothesen auftreten [ 5 ]. Zwischen der primären Infektion und dem Auftreten von Symptomen können Jahre liegen.…”

Section: Infektionskrankheiten Durch Den Kontakt Mit Landwirtschaftli...unclassified

Bacterial zoonoses of public health importance in Germany—incidence, distribution, and modes of transmission

Wilking

Beermann

Boone

et al. 2023

Bundesgesundheitsbl

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ZusammenfassungBakterielle zoonotische Erreger sind häufig Auslöser von Erkrankungen mit teilweise schweren Verläufen. Sie sind wechselseitig zwischen Tieren (sowohl Wild- als auch Haustieren) und Menschen übertragbar. Die Transmissionswege sind sehr variabel, so kann die Übertragung u. a. durch orale Aufnahme über Lebensmittel, respiratorische Aufnahme über Tröpfchen und Aerosole sowie über Vektoren wie Zeckenstiche oder Nagerkontakte stattfinden. In diesem Zusammenhang sind auch das Auftreten und die Verbreitung von antibiotikaresistenten bakteriellen Erregern von zunehmender Bedeutung für den öffentlichen Gesundheitsschutz.Die Ausbreitung zoonotischer Erreger wird aktuell durch zahlreiche Faktoren verstärkt. Dazu gehören die Zunahme des internationalen Warenverkehrs, die Einengung der Lebensräume von Tieren und der dadurch zunehmend engere Kontakt zwischen Menschen und Wildtieren. Aber auch eine veränderte Tierhaltung in der Landwirtschaft und Klimaveränderungen können zur Ausbreitung beitragen. Der öffentliche Gesundheitsschutz und die Erforschung von Zoonosen sind deshalb von besonderer krankheitspräventiver, aber auch gesellschaftlicher, politischer und wirtschaftlicher Bedeutung.Ziel dieses Übersichtsartikels ist es, anhand von Beispielen die Spannbreite von Infektionskrankheiten darzustellen, die durch bakterielle zoonotische Erreger ausgelöst werden. Die unterschiedlichen Transmissionswege, epidemischen Potenziale und epidemiologischen Maßzahlen der beispielhaft gewählten Krankheiten sind Herausforderungen für den öffentlichen Gesundheitsdienst, den Tiergesundheitsdienst und die Lebensmittelüberwachung, deren Aufgabe es ist, die Bevölkerung vor diesen Infektionskrankheiten zu schützen.

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‘Chronic Q fever-related complications and mortality: data from a nationwide cohort’ – Author’s reply

Cited by 8 publications

References 5 publications

Case report: a missed case of chronic Q fever infective endocarditis demonstrating the ongoing diagnostic challenges

Case report: a missed case of chronic Q fever infective endocarditis demonstrating the ongoing diagnostic challenges

The prognostic value of serological titres for clinical outcomes during treatment and follow-up of patients with chronic Q fever

Bacterial zoonoses of public health importance in Germany—incidence, distribution, and modes of transmission

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