Should Acute Q-Fever Patients be Screened for Valvulopathy to Prevent Endocarditis?

Lange, Marit M A de; Gijsen, Laura E V; Wielders, Cornelia C H; Hoek, Wim van der; Scheepmaker, Arko; Schneeberger, Peter M.

doi:10.1093/cid/ciy128

Cited by 8 publications

(5 citation statements)

References 26 publications

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“…Fortunately, only 1-2% of acute cases progress to chronic infection, whose main manifestation is endocarditis (70% of chronic cases). Other manifestations include intravascular infection, osteomyelitis, and chronic hepatitis (de Lange et al, 2018). The estimated risk of developing endocarditis from a valvular dysfunction is 39%; male patients >40 years-old also have a high risk, especially in the presence of bicuspid valves and/or a high immunoglobulin G (IgG) antiphospholipid (APL) titer >90 units (Million et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

Ten-year experience of Q fever endocarditis in a tertiary cardiac center in Saudi Arabia

Elzein

Alsherbeeni

Alnajashi

et al. 2019

International Journal of Infectious Diseases

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Background: Q fever endocarditis (QFE) is considered rare in the Middle East, with only a few cases reported in Saudi Arabia. The aim of this study is to report on the experience of our centre on QFE. Methods: We searched the medical records for cases of QFE at our cardiac center from 2009-2018. Demographic data, clinical features, serology and echocardiography results, treatments, and outcomes were assessed. Results: Five hundred and two cases of infective endocarditis were detected over the 10 years period. Among the 234 patients with blood culture-negative endocarditis (BCNE), 19 (8.10%) had QFE. All patients had a previously diagnosed congenital heart disease except for one patient with rheumatic heart disease. Eleven patients had received a bovine jugular vein-related implant, e.g., a Melody valve (seven patients) or Contegra conduit (four patients). Coinfection was detected in three patients, and immunologic and embolic phenomena were observed in five patients. All patients received a combination of hydroxychloroquine and doxycycline, with good outcomes. Only two patients required surgery while on treatment. Two patients died several months after treatment; the cause of death was not identified. Conclusion: This study indicates that Q fever exists in our population. The majority of the patients had congenital heart disease (CHD) and underwent bovine jugular vein implants. Patients with CHD are at increased risk of infective endocarditis. Bovine jugular vein implants increase the risk of infective and possibly QFE. Proper exclusion of Q fever is warranted in all BCNE and possibly in culture-positive endocarditis cases in areas endemic to Q fever. Key points: We presented the largest series of Q fever endocarditis cases in Saudi Arabia. We showed that Q fever is not rare in the Middle East and suggest that it should be considered in all blood culture-negative endocarditis cases.

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Section: Introductionmentioning

confidence: 99%

Ten-year experience of Q fever endocarditis in a tertiary cardiac center in Saudi Arabia

Elzein

Alsherbeeni

Alnajashi

et al. 2019

International Journal of Infectious Diseases

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“…Screening and follow-up of these patients could certainly have reduced the observed mortality. Nonetheless, in The Netherlands, echocardiography is no longer recommended in the case of acute Q fever [4,5]. Two recent studies support our preventable diagnosis strategies.…”

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confidence: 98%

“…Based on the 30 years' experience of the French National reference center for Q fever and the largest Q fever cohort recently published, we identified some discrepancies regarding Q fever diagnosis and therapeutic management performed in The Netherlands (Table 1) [2,3]. We have demonstrated the necessity for detecting underlying valvulopathy at the acute phase of the disease, because it is a predictive factor for evolution towards persistent cardiovascular infection [4,5]. Consequently, we systematically proposed transthoracic echocardiography in the case of acute Q fever [6,7].…”

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confidence: 99%

Re: chronic Q-fever-related complications and mortality: data from a nationwide cohort

Melenotte

Million

Raoult

2019

Clinical Microbiology and Infection

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We read with interest the article by van Roeden et al. about the chronic Q fever mortality rate in The Netherlands. We were surprised to observe that the mortality rate reported from The Netherlands was 3.3 times higher than that observed from the French National Reference Center for Q fever [1,2]. In our experience, among the 678 patients with persistent cardiovascular focalized infection diagnosed between 1991 and 2016, 55 died (55/678, 8%): 43 with endocarditis (43/533, 8%) and 16 with a vascular infection (16/145, 11%); among these four had both Coxiella burnetii endocarditis and vascular persistent infection (4/ 49, 8.1%) [2]. The mortality rate was 1.8 (95%CI 1.4e2 .3) per 100 person-years and the 5-year survival for cardiovascular persistent C. burnetii infection was 73%.(see Table 1) In The Netherlands after the 2009e2011 epidemics, of the 439 patients diagnosed with chronic Q fever 118 died (27%), and of these 54 (35%) had a vascular infection, 27 (32%) had endocarditis, and 20 (47%) had both C. burnetii endocarditis and vascular infection. The 5-year survival for proven and probable chronic Q fever was 64% [1]. Persistent C. burnetii cardiovascular infection is a deadly disease if left untreated, but is ultimately curable, so how can the high mortality rate in The Netherlands be explained?

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“…In another long-term follow-up study performed in 2016–2017 among 133 patients with cardiac valvulopathy in the Netherlands, six patients (4.5%) were found to have a chronic Q fever infection [ 9 ]. In contrast to our study, seroprevalence was only measured during the study period in 2016–2017 without knowledge of serological results before this study period.…”

Section: Discussionmentioning

confidence: 99%

Long-term serological follow-up after primary Coxiella burnetii infection in patients with vascular risk factors for chronic Q fever

Buijs

Stuart

Oosterheert

et al. 2021

Eur J Clin Microbiol Infect Dis

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We evaluated the long-term serological follow-up of patients with vascular risk factors for chronic Q fever that were previously Coxiellaburnetii seropositive. C. burnetii phase I IgG titers were reevaluated in patients that gave informed consent or retrospectively collected in patients already deceased or lost to follow-up. Of 107 patients, 25 (23.4%) became seronegative, 77 (72.0%) retained a profile of past resolved Q fever infection, and five (4.7%) developed chronic Q fever. We urge clinicians to stay vigilant for chronic Q fever beyond two years after primary infection and perform serological testing based on clinical presentation.

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Should Acute Q-Fever Patients be Screened for Valvulopathy to Prevent Endocarditis?

Abstract: We found no difference in occurrence of chronic Q-fever between patients with or without a newly detected valvulopathy at time of acute Q-fever diagnosis. Thus, universal screening is not justified and would lead to unnecessary and undesirable long-term antibiotic use.

Cited by 8 publications

References 26 publications

Ten-year experience of Q fever endocarditis in a tertiary cardiac center in Saudi Arabia

Ten-year experience of Q fever endocarditis in a tertiary cardiac center in Saudi Arabia

Re: chronic Q-fever-related complications and mortality: data from a nationwide cohort

Long-term serological follow-up after primary Coxiella burnetii infection in patients with vascular risk factors for chronic Q fever

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