Prevalence of Chronic Q Fever in Patients with a History of Cardiac Valve Surgery in an Area Where Coxiella burnetii Is Epidemic

Kampschreur, Linda M.; Oosterheert, Jan Jelrik; Hoepelman, Andy I. M.; Lestrade, P; Renders, Nicole H. M.; Elsman, Peter; Wever, Peter C.

doi:10.1128/cvi.00185-12

Cited by 32 publications

(42 citation statements)

References 26 publications

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“…This study emphasizes the risk of endocarditis for acute Q fever patients with valvulopathy [14,64], and shows that it is possible to prevent endocarditis with doxycycline/hydroxychloroquine therapy. However, in other contexts, the benefit of screening every acute fever patient for valvulopathy may not be as significant [65]. Other patient groups may have lower incidence of valvulopathy and certain strains of C. burnetii may have more or less propensity for endocarditis [14].…”

Section: Expert Commentary and Five-year Viewmentioning

confidence: 99%

Antimicrobial therapies for Q fever

Kersh¹

2013

Expert Review of Anti-infective Therapy

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Summary Q fever is caused by the bacterium Coxiella burnetii and has both acute and chronic forms. The acute disease is a febrile illness often with headache and myalgia that can be self-limiting whereas the chronic disease typically presents as endocarditis and can be life threatening. The normal therapy for the acute disease is a two week course of doxycycline, whereas chronic disease requires 18-24 months of doxycycline in combination with hydroxychloroquine. Alternative treatments are used for pregnant women, young children, and those who cannot tolerate doxycycline. Doxycycline resistance is rare but has been reported. Co-trimoxazole is a currently recommended alternative treatment, but quinolones, rifampin, and newer macrolides may also provide some benefit.

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Section: Expert Commentary and Five-year Viewmentioning

confidence: 99%

Antimicrobial therapies for Q fever

Kersh¹

2013

Expert Review of Anti-infective Therapy

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“…In the Dutch cohort, after primary infection, progression to vascular chronic Q fever in patients with an abdominal aortic aneurysm was high, 30.8% compared with 7.8% progression to Q fever endocarditis in patients with a history of cardiac valve surgery (Kampschreur et al . b; Hagenaars ). Patients with vascular chronic Q fever can present with a life‐threatening acute complication, such as a symptomatic aneurysm, ruptured aneurysm, mycotic aneurysm, aorto‐duodenal fistula or aorto‐caval fistula.…”

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confidence: 99%

Histological characteristics of the abdominal aortic wall in patients with vascular chronic Q fever

Hagenaars

Koning

Haak

et al. 2014

Int J Experimental Path

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The aim of this study was to describe specific histological findings of the Coxiella burnetii-infected aneurysmal abdominal aortic wall. Tissue samples of the aneurysmal abdominal aortic wall from seven patients with chronic Q fever and 15 patients without evidence of Q fever infection were analysed and compared. Chronic Q fever was diagnosed using serology and tissue PCR analysis. Histological sections were stained using haematoxylin and eosin staining, Elastica van Gieson staining and immunohistochemical staining for macrophages (CD68), T lymphocytes (CD3), T lymphocyte subsets (CD4 and CD8) and B lymphocytes (CD20). Samples were scored by one pathologist, blinded for Q fever status, using a standard score form. Seven tissue samples from patients with chronic Q fever and 15 tissue samples from patients without Q fever were collected. Four of seven chronic Q fever samples showed a necrotizing granulomatous response of the vascular wall, which was characterized by necrotic core of the arteriosclerotic plaque (P = 0.005) and a presence of high numbers of macrophages in the adventitia (P = 0.007) distributed in typical palisading formation (P = 0.005) and surrounded by the presence of high numbers of T lymphocytes located diffusely in media and adventitia. Necrotizing granulomas are a histological finding in the C. burnetii-infected aneurysmal abdominal aortic wall. Chronic Q fever should be included in the list of infectious diseases with necrotizing granulomatous response, such as tuberculosis, cat scratch disease and syphilis.

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“…Further, 1-5% of (often asymptomatically) infected individuals progress to persistent infection also known as chronic Q fever. Chronic Q fever has a poor prognosis and manifests as endocarditis, infected aneurysms or vascular prosthesis infection in individuals with specific risk factors (1, 3).…”

Section: Introductionmentioning

confidence: 99%

Coxiella burnetii epitope-specific T-cell responses in chronic Q fever patients

Scholzen¹,

Richard

Moise

et al. 2019

Preprint

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24Infection with Coxiella burnetii, the causative agent of Q fever, can result in life-threatening 25 persistent infection. Reactogenicity hinders worldwide implementation of the only licensed 26 human Q fever vaccine. We previously demonstrated long-lived immunoreactivity in individuals 27 with past symptomatic and asymptomatic Coxiella infection (convalescents) to promiscuous 28 HLA-class II C. burnetii epitopes, providing the basis for a novel T-cell-targeted subunit 29 vaccine. Here we investigated in a cohort of 22 individuals with persistent infection (chronic Q 30 fever) whether they recognize the same set of epitopes, or distinct epitopes that could be 31 candidates for a therapeutic vaccine or aid in the diagnosis of persistent infection. 32Individuals with chronic Q fever showed strong class II epitope-specific cultured ELISpot 33 responses largely overlapping with the peptide repertoire identified previously for convalescents. 34Five additional peptides were recognized more frequently by chronic subjects, but there was no 35 combination of epitopes uniquely recognized by or non-reactive in chronic Q fever subjects. 36Consistent with more recent/prolonged exposure, we found, however, stronger direct ex vivo 37 responses to whole-cell C. burnetii and individual peptides in direct ELISpot than in 38 convalescents. 39In conclusion, we have validated and expanded a previously published set candidate epitopes for 40 a novel T-cell targeted subunit Q fever vaccine in the context of chronic Q fever patients and 41 demonstrated that they successfully mounted a T-cell response comparable to that of 42 convalescents. Finally, we demonstrate that individuals treated for chronic Q fever mount a 43 broader ex vivo response to class II epitopes than convalescents, which could be explored for 44 diagnostic purposes. 45 46 Q fever is a zoonotic disease that is endemic in many countries worldwide. It is caused by the 47 environmentally highly stable small Gram-negative coccobacillus Coxiella burnetii, which is 48 transmitted to humans predominantly by aerosol from infected ruminants such as goats, sheep 49 and cattle (1). Outbreaks usually occur in the occupational setting including the livestock 50 industry and deployed military personnel (1). Coxiella outbreaks can also occur in the general 51 population, the largest to date being the outbreak in the Netherlands from 2007-2010 with an 52 estimated 40,000 infections at the center of the epidemic area alone (2). While infection remains 53 asymptomatic in an estimated 50-60% of individuals and acute symptomatic infection is readily 54 treatable with antibiotics, a large proportion (10-20%) of individual with acute Q fever later 55 develop Q fever fatigue syndrome. Further, 1-5% of (often asymptomatically) infected 56 individuals progress to persistent infection also known as chronic Q fever. Chronic Q fever has a 57 poor prognosis and manifests as endocarditis, infected aneurysms or vascular prosthesis infection 58 in individuals with specific risk factors (1, 3).5...

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Prevalence of Chronic Q Fever in Patients with a History of Cardiac Valve Surgery in an Area Where Coxiella burnetii Is Epidemic

Cited by 32 publications

References 26 publications

Antimicrobial therapies for Q fever

Antimicrobial therapies for Q fever

Histological characteristics of the abdominal aortic wall in patients with vascular chronic Q fever

Coxiella burnetii epitope-specific T-cell responses in chronic Q fever patients

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