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[Prosthetic valve endocarditis due to Coxiella burnetii: six cases]
C Auzary1, C Pinganaud, O Launay
1Service de médecine interne, centre hospitalier de Moulins-Yzeure, 10, avenue du Général-de-Gaulle, BP 609, 03006 Moulins, France. c.auzary@ch-moulins-yzeure.fr
Purpose:
Prosthetic valve endocarditis is a dangerous complication of valvular surgery (3-6%). Among involved pathogens, Coxiella burnetii is an occasional agent, though isolated with increasing frequency. We report our experience with this peculiar endocarditis and lay stress on specific diagnostic and therapeutic difficulties.
Methods:
Between 1990 and 1995, six patients retrospectively met the diagnosis criteria for definite endocarditis due to Coxiella burnetii.
Results:
Five Algerian men and one French woman presented with prosthetic valve endocarditis with negative blood cultures (on bioprosthesis: four cases, on mechanical valve: two cases). The main clinical and biological feature was febrile congestive heart failure with hepatomegaly, splenomegaly, hepatic and renal abnormalities, inflammatory syndrome, hypergammaglobulinemia, anemia and lymphopenia. Serological testing for Coxiella burnetii provided diagnosis in all cases. Echocardiography displayed vegetations in all cases. Valvular replacement was performed in four patients. With antibiotic therapy including doxycycline or/and hydroxychloroquine, quinolones or rifampicine, all patients experienced complete clinical, biological and echographic remission.
Conclusion:
Q fever prosthetic valve endocarditis presents as a systemic disorder occurring in patients with valvular heart disease. From now on, early diagnosis and efficient medical treatment may provide permanent prosthetic sterilization.
Insights
Coxiella burnetii can cause prosthetic valve endocarditis, a serious complication. Early diagnosis via serology and treatment with antibiotics like doxycycline can lead to complete recovery in Q fever endocarditis patients.
Area of Science:
- Infectious Diseases
- Cardiology
- Valvular Heart Surgery
Background:
- Prosthetic valve endocarditis (PVE) is a severe complication following valvular surgery.
- Coxiella burnetii is an increasingly recognized cause of PVE, presenting diagnostic and therapeutic challenges.
Observation:
- A retrospective study identified six patients with PVE caused by Coxiella burnetii between 1990 and 1995.
- Patients presented with negative blood cultures, febrile congestive heart failure, and systemic involvement including hepatosplenomegaly and organ dysfunction.
Findings:
- Diagnosis was confirmed in all cases by serological testing for Coxiella burnetii.
- Echocardiography revealed vegetations in all patients.
- Treatment involved valve replacement in four patients and antibiotic regimens including doxycycline, hydroxychloroquine, quinolones, or rifampicin, leading to complete remission.
Implications:
- Q fever PVE manifests as a systemic illness in patients with underlying valvular heart disease.
- Prompt diagnosis and effective antibiotic therapy are crucial for achieving prosthetic valve sterilization and patient recovery.