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Q fever endocarditis

M J Tobin, N Cahill, G Gearty

    The American Journal of Medicine
    |March 1, 1982
    PubMed
    Summary
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    Q fever endocarditis, caused by Coxiella burnetii, is often missed and presents with varied symptoms. Early diagnosis and prolonged antibiotic therapy are crucial for managing this serious infection.

    Area of Science:

    • Infectious Diseases
    • Cardiology
    • Microbiology

    Background:

    • Coxiella burnetii causes Q fever, a zoonotic infection with worldwide distribution.
    • Q fever endocarditis is rare, with few reported cases outside specific regions.
    • Diagnosis and management of Q fever endocarditis remain challenging.

    Purpose of the Study:

    • To describe the clinical features, diagnosis, treatment, and outcomes of Q fever endocarditis.
    • To highlight the importance of considering Q fever endocarditis in culture-negative endocarditis cases.
    • To review diagnostic markers and therapeutic strategies for Q fever endocarditis.

    Main Methods:

    • Retrospective case series of 10 patients with Q fever endocarditis.
    • Analysis of clinical presentation, diagnostic findings, treatment regimens, and patient outcomes.

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  • Serological confirmation of Coxiella burnetii infection using complement-fixing antibodies to Phase I antigen.

    • Main Results:

    • Most patients lacked a history of environmental exposure.
    • Mitral and aortic valves were commonly affected; prosthetic valves were involved in three patients.
    • Hepatic involvement, thrombocytopenia, and hypergammaglobulinemia were significant diagnostic indicators.
    • Antibiotic therapy (tetracycline-based) showed variable efficacy; relapse occurred after treatment cessation.
    • Five patients required valve replacement, and five died, with a median survival of 36 months.

    Conclusions:

    • Q fever endocarditis is likely underdiagnosed.
    • Clinicians should consider Q fever endocarditis in culture-negative endocarditis cases.
    • Optimal treatment duration requires further investigation, and prolonged therapy may be necessary.