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

Lévy, Pierre-Yves; Drancourt, Michel; Etienne, Jérôme; Auvergnat, J.Ch.; Beytout, Jean; Sainty, J. M.; Goldstein, F; Raoult, Didier

doi:10.1128/aac.35.3.533

Cited by 113 publications

(64 citation statements)

References 37 publications

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“…Combination therapy using two antibiotics active against C burnetii in vitro appear to be successful. Specifically, the combination of a fluoroquinolone with either doxycyline or rifampin were successful in controlling infection, although relapse rates were as high as 50% at discontinuation despite prolonged therapy of up to three years (33,34). More recently, the combination of doxycycline and chloroquine was compared with doxycycline and ofloxacin in a nonrandomized, nonblinded study (35).…”

Section: Discussionmentioning

confidence: 99%

Q fever endocarditis: A case report and review of the literature

Deyell

Chiu²,

Ross

et al. 2006

Canadian Journal of Cardiology

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E ndocarditis is the most common presentation of chronic Q fever, a zoonosis caused by the obligate intracellular bacteria Coxiella burnetii. Commonly believed to be a rare disorder, it has been estimated to account for up to 5% of all endocarditis cases worldwide (1-3). It occurs almost exclusively in patients who have pre-existing valvular disease or who are immunocompromised (4). Unlike typical cases of endocarditis, the clinical presentation of chronic Q fever is often nonspecific. Furthermore, specialized techniques are required for identification of the organism, and echocardiographic evidence of infection is frequently absent (5). Without prompt recognition and appropriate antimicrobial therapy, the course of Q fever endocarditis is severe and potentially fatal. The following case demonstrates many of the clinical features of chronic Q fever and highlights the difficulty of obtaining the diagnosis. CASE PRESENTATIONA 31-year-old Caucasian man presented to a walk-in clinic complaining of progressive, exertional shortness of breath. He had moved to Calgary, Alberta, from Nova Scotia, where he had worked on a dairy farm, two years prior. Due to pre-existing congenital valvular heart disease, he was referred to the Adult Congenital Cardiology Clinic at the University of Calgary (Calgary, Alberta). The patient could barely climb one flight of stairs without significant shortness of breath, and had developed orthopnea and paroxysmal nocturnal dyspnea. He described occasional palpitations, but denied any syncopal episodes, chest discomfort or peripheral edema. There were no symptoms suggestive of systemic infection.Of note, the patient had been diagnosed with congenital aortic stenosis at the age of eight months and underwent open aortic valvulotomy. The patient was found to have a trileaflet valve with significant fusion of the leaflets. Catheterization at the age of 10 years revealed a peak residual gradient of 25 mmHg across the aortic valve with mild aortic insufficiency. Echocardiograms at the ages of 18 and 22 years demonstrated peak gradients of 37 mmHg and 56 mmHg, respectively, moderate aortic insufficiency and preserved left ventricular function. The patient had no cardiology follow-up after the age of 22 years.Physical examination revealed a blood pressure of 110/50 mmHg, a heart rate of 82 beats/min and a normal The case of a 31-year-old man from Alberta diagnosed with Q fever endocarditis is presented. To the authors' knowledge, this is the first case of Q fever endocarditis diagnosed in the province of Alberta. The patient had undergone open valvulotomy for congenital aortic stenosis as an infant. He presented with congestive heart failure secondary to severe aortic regurgitation and underwent mechanical aortic valve replacement. Early failure of the mechanical prosthesis and numerous laboratory abnormalities prompted an investigation for endocarditis, which was initially negative. Markedly positive serology eventually established the diagnosis of chronic Q fever. The patient subsequently underwent...

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Section: Discussionmentioning

confidence: 99%

Q fever endocarditis: A case report and review of the literature

Deyell

Chiu²,

Ross

et al. 2006

Canadian Journal of Cardiology

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show abstract

“…The acidic conditions of the phagolysosome, where the organism resides, may inhibit antibiotic activity. 66 Clinical response tends to persist as long as the drug regimen continues, but viable C burnetii can be recovered from valve tissue even after years of antimicrobial therapy. 66 Cures of IE after treatment with a combination of doxycycline and hydroxychloroquine (to alkalinize the phagolysosome) for 1 year were reported in 20 patients.…”

Section: Coxiella Burnetiimentioning

confidence: 99%

“…66 Clinical response tends to persist as long as the drug regimen continues, but viable C burnetii can be recovered from valve tissue even after years of antimicrobial therapy. 66 Cures of IE after treatment with a combination of doxycycline and hydroxychloroquine (to alkalinize the phagolysosome) for 1 year were reported in 20 patients. 65 However, no long-term follow-up was published regarding these patients.…”

Section: Coxiella Burnetiimentioning

confidence: 99%

“…Doxycycline with trimethoprim/sulfamethoxazole, rifampin, or fluoroquinolones is the mainstay of therapy. 66 However, eradication of the organisms from vegetations with medical therapy is unlikely, and reinfection of prosthetic material after surgical replacement of infected valves commonly occurs. The acidic conditions of the phagolysosome, where the organism resides, may inhibit antibiotic activity.…”

Section: Coxiella Burnetiimentioning

confidence: 99%

“…65 To prevent reinfection of the newly implanted prosthetic valve from dormant sites of infection, many experts recommend that antimicrobial therapy be continued long-term and possibly indefinitely. 66 Some authorities have suggested a minimum of 3 years' therapy once phase I IgG antibody titers drop below 1:400 and IgA phase I antibodies are undetectable.…”

Section: Coxiella Burnetiimentioning

confidence: 99%

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