Thrombosis and antiphospholipid antibody syndrome during acute Q fever

Million, Matthieu; Bardin, Nathalie; Bessis, Simon; Nouiakh, Nadia; Douliery, Charlaine; Edouard, Sophie; Angelakis, Emmanouil; Bosseray, A.; Épaulard, Olivier; Branger, S.; Chaudier, B.; Blanc-Laserre, Karine; Ferreira-Maldent, Nicole; Demonchy, Élisa; Roblot, F.; Reynes, Jacques; Djossou, Félix; Protopopescu, Camélia; Carrieri, Patrizia; Camoin-Jau, Laurence; Mège, Jean‐Louis; Raoult, Didier

doi:10.1097/md.0000000000007578

Cited by 24 publications

(25 citation statements)

References 36 publications

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“…Apart from ANCA, aPL was also analysed in our study. In terms of the relationship between aPL and IE, it has been indicated that IgG aPL might be associated with Q fever endocarditis and aPL antibodies have previously been shown to be associated with thrombosis during acute Q fever 19 20. In our study, aPL-positive patients did not have positive serology of Coxiella .…”

Section: Discussionsupporting

confidence: 37%

Clinical characteristics of infective endocarditis in patients with antineutrophil cytoplasmic antibody or antiphospholipid antibody: a retrospective study in Shanghai

Zhou

Teng

et al. 2020

BMJ Open

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ObjectiveThis study aimed to characterise rheumatic manifestations and autoantibodies in 432 patients diagnosed with infective endocarditis (IE) in Shanghai.Design, setting and participantsA retrospective study was conducted in Ruijin Hospital from 1997 to 2017. The clinical and laboratory characteristics of a total of 432 patients were analysed. In addition, the differences between patients with positive and negative antineutrophil cytoplasmic antibodies (ANCA) and antiphospholipid (aPL) antibodies as well as the survival rates of these patients were compared.ResultsA total of 432 patients, including 278 male patients and 154 female patients, were included. The mean age of the patients was 46±16 years. A total of 346 patients (80%) had cardiac surgery, and 55 patients (13%) died in the hospital. Among the IE patients, 104 were tested for either ANCA or aPL and were analysed in different groups. Twenty-one (24%) positive ANCA patients were proteinase 3-ANCA positive. Compared with the ANCA-negative group, patients with positive ANCA had higher IgM (p=0.048), lower haemoglobin (p=0.001) and a higher likelihood of arthritis (p=0.003). Twenty-one (40%) aPL-positive patients had a higher erythrocyte sedimentation rate than was found in the aPL-negative group (p=0.003). In addition, the survival rate of the ANCA-positive IE patients was lower (p=0.032) than that of the ANCA-negative group, while there was no difference between patients with or without aPL antibodies (p=0.728).ConclusionThis study supports the claim that rheumatic manifestations and autoantibodies are frequently present in patients with IE and might lead to early misdiagnosis. Physicians should pay more attention to the measurement of autoantibodies in these patients.

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Section: Discussionsupporting

confidence: 37%

Clinical characteristics of infective endocarditis in patients with antineutrophil cytoplasmic antibody or antiphospholipid antibody: a retrospective study in Shanghai

Zhou

Teng

et al. 2020

BMJ Open

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“…In one study, a very high IgG (APL) titer was associated with a relative risk of 24.9 for endocarditis development in patients with acute Q fever (Million et al, 2015). Fortunately, treatment of acute Q fever with hydroxychloroquine prevents persistent APL and reduces the number of associated complications, including thrombosis (Million et al, 2017). Three of our patients were initially diagnosed with systemic lupus nephritis.…”

Section: Discussionmentioning

confidence: 78%

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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“…Secondary cases of APS due to infectious agents potentially evolving into CAPS have been reported and include infections from hepatitis C virus, herpes zoster, as well as bacteria, fungi and parasites and acute Q fever ( 27 ).…”

Section: Can the Thromboembolic Diathesis During Some Cases Of Covmentioning

confidence: 99%

Entangling COVID-19 associated thrombosis into a secondary antiphospholipid antibody syndrome: Diagnostic and therapeutic perspectives (Review)

et al. 2020

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The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel β coronavirus that is the etiological agent of the pandemic coronavirus disease 2019 (COVID-19) that at the time of writing (June 16, 2020) has infected almost 6 million people with some 450,000 deaths. These numbers are still rising daily. Most (some 80%) cases of COVID-19 infection are asymptomatic, a substantial number of cases (15%) require hospitalization and an additional fraction of patients (5%) need recovery in intensive care units. Mortality for COVID-19 infection appears to occur globally between 0.1 and 0.5% of infected patients although the frequency of lethality is significantly augmented in the elderly and in patients with other comorbidities. The development of acute respiratory distress syndrome and episodes of thromboembolism that may lead to disseminated intravascular coagulation (DIC) represent the primary causes of lethality during COVID-19 infection. Increasing evidence suggests that thrombotic diathesis is due to multiple derangements of the coagulation system including marked elevation of D-dimer that correlate negatively with survival. We propose here that the thromboembolic events and eventually the development of DIC provoked by SARS-CoV-2 infection may represent a secondary anti-phospholipid antibody syndrome (APS). We will apply both Baconian inductivism and Cartesian deductivism to prove that secondary APS is likely responsible for coagulopathy during the course of COVID-19 infection. Diagnostic and therapeutic implications of this are also discussed.

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Thrombosis and antiphospholipid antibody syndrome during acute Q fever

Abstract: Supplemental Digital Content is available in the text

Cited by 24 publications

References 36 publications

Clinical characteristics of infective endocarditis in patients with antineutrophil cytoplasmic antibody or antiphospholipid antibody: a retrospective study in Shanghai

Clinical characteristics of infective endocarditis in patients with antineutrophil cytoplasmic antibody or antiphospholipid antibody: a retrospective study in Shanghai

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

Entangling COVID-19 associated thrombosis into a secondary antiphospholipid antibody syndrome: Diagnostic and therapeutic perspectives (Review)

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