Chronic Q fever: A missed prosthetic valve endocarditis possibly for years

Area of Science:

• Infectious Diseases
• Cardiology
• Microbiology

Background:

• Chronic Q fever endocarditis is a severe manifestation of Coxiella burnetii infection.
• It typically affects individuals with pre-existing heart conditions, often presenting insidiously with atypical symptoms.
• Prosthetic valve endocarditis due to Coxiella burnetii is rare but associated with significant morbidity.

Purpose of the Study:

• To report a case of Coxiella burnetii prosthetic valve endocarditis.
• To highlight the diagnostic challenges and importance of considering Q fever in endocarditis cases.
• To emphasize the need for timely diagnosis and appropriate management to improve patient outcomes.

Main Methods:

• Case report of a 53-year-old male with recurrent mechanical mitral valve dehiscence.
• Diagnosis confirmed by positive serology for Coxiella burnetii (Indirect Immunofluorescence).
• Treatment involved a combination of hydroxychloroquine, doxycycline, and surgical valve replacement.

Main Results:

• The patient experienced recurrent valve issues over 9 years, with initial surgeries lacking Q fever suspicion.
• Diagnosis was established late via serological testing.
• Combined medical and surgical treatment led to a favorable outcome.

Conclusions:

• Coxiella burnetii endocarditis can present with atypical manifestations, delaying diagnosis.
• Failure to consider Q fever may result in multiple cardiac surgeries, increased morbidity, and mortality.
• Prompt diagnosis and comprehensive treatment are essential for managing Q fever endocarditis.