Coxiella burnetii infection of an aortic graft: surgical view and a word of caution

Abstract

A 30-year-old-man presented with an aortic graft infection. Polymerase chain reaction study identified the infectious organism as Coxiella burnetii, a strictly intracellular pathogen that causes Q fever in humans. The patient was successfully treated by removal of the infected graft, implantation of homograft aortic tube, and specific antibiotic therapy. He is doing well after 6 months, with no evidence of recurrent homograft infection on transthoracic echocardiography. C. burnetii vascular graft infections may be underdiagnosed because of lack of recognition. We suggest that serologic tests for C. burnetii be routinely performed in the presence of unexplained febrile illness or pain in patients with a history of underlying vascular disease.

Coxiella burnetii vascular graft infection

“…C. burnetii account for some of these culture-negative vascular graft infections. Very few cases of C. burnetii infection of a vascular graft have been reported [ 2 - 5 ]. All previously reported cases were diagnosed by serology.…”

“…All previously reported cases were diagnosed by serology. The confirmation of the vascular localization of C. burnetii infection was obtained after the serological diagnosis of chronic Q fever by culture [ 3 ] and/or DNA amplification of C. burnetii from vascular graft samples [ 3 - 5 ]. Here, we report a case of C. burnetii vascular graft infection diagnosed by broad-range PCR from a surgical sample of a para-prosthetic abscess which was confirmed by serology.…”

Coxiella burnetii Infection in Hemodialysis and Other Vascular Grafts

“…The PubMed search yielded 29 cases of Coxiella burnetii endovascular graft infection, all of them involving large vascular grafts. 2 , 3 , 7 , 10 , 11 , 15 , 18 , 22 , 26 , 28 , 32 , 36 , 42 , 43 However, 15 of these cases, all described in a single study, 3 could not be included because the patients’ treatment and clinical course were not individually described.…”

“…The mean time onset of chronic Q fever after graft placement was 4.6 years (range, 3 mo-15 yr) and in all previous cases the disease affected great vessels. The dacron aortobifemoral bypass 10 , 26 , 28 , 36 and infrarenal aortic graft 2 , 7 , 15 , 40 were the most common involved grafts (4 patients each), followed by thoracic aortic graft (3 patients), 11 , 42 , 43 PTFE subclavian-subclavian cross-over (1 patient), 32 aortobiiliac endoprosthesis (1 patient), 22 aortic endoprosthesis (1 patient), 18 and left humeral-axillary AV PTFE graft in our case. Fever and local pain were reported in 8 cases respectively, weight loss was reported in 4 cases, embolic phenomena in 3 cases, gastrointestinal symptoms (nausea, vomiting, and diarrhea) and respiratory symptoms (dyspnea and fatigue) in 2 cases, respectively, and other cases reported new symptoms like renal failure, hepatosplenomegaly, and purulent discharge, as was our case (see Table 1 ).…”

“…Regarding surgical treatment, all patients underwent partial or complete resection of the infected grafts. 2 , 7 , 10 , 11 , 15 , 18 , 22 , 26 , 28 , 32 , 36 , 42 , 43 At follow-up, 12 patients were either cured or still on treatment with a favorable evolution, 1 patient, in which the surgical procedure was not described, died at 9 months after the diagnosis 7 and in 2 cases the evolution was not available in the study. The most common antibiotic treatment for this entity was doxycycline and hydroxycloroquine (see Table 2 ).…”