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Chronic Q fever

W P Turck, G Howitt, L A Turnberg

    The Quarterly Journal of Medicine
    |April 1, 1976
    PubMed
    Summary
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    Chronic Q fever, often presenting as endocarditis or liver disease, affects patients with valvular heart disease. Early diagnosis and prolonged antibiotic treatment, sometimes with valve surgery, improve long-term survival.

    Area of Science:

    • Infectious Diseases
    • Cardiology
    • Hepatology

    Background:

    • Chronic Q fever is a serious infection caused by Coxiella burnetii.
    • It frequently affects individuals with underlying valvular heart disease, including prosthetic valves.
    • Exposure to farms or farm products is a common history.

    Purpose of the Study:

    • To describe the clinical features, diagnostic findings, and treatment outcomes of chronic Q fever.
    • To identify factors that may help differentiate Q fever endocarditis from bacterial endocarditis.
    • To evaluate the efficacy of prolonged antibiotic therapy and surgical intervention.

    Main Methods:

    • Retrospective case series analysis of sixteen patients with chronic Q fever.
    • Clinical data collection including patient history, physical examination, laboratory tests (serology, liver function tests), and imaging.

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  • Review of hepatic histology and treatment outcomes (medical therapy, valve replacement surgery).

    • Main Results:

    • All patients had valvular heart disease; mitral and aortic valves were most commonly involved.
    • Arterial and venous thromboembolism were frequent complications.
    • Liver involvement, including abnormal liver function tests and histology, was present in all patients.
    • Thrombocytopenia and purpuric rash were observed in a significant number of patients.
    • Prolonged antibiotic treatment (tetracycline-based) and valve replacement surgery led to improved survival rates.

    Conclusions:

    • Chronic Q fever can present with diverse clinical manifestations, including endocarditis and liver disease.
    • Hepatomegaly, liver involvement, and thrombocytopenia may aid in differentiating Q fever endocarditis from bacterial endocarditis.
    • Long-term antibiotic therapy, often combined with valve replacement surgery, is crucial for managing chronic Q fever and improving patient outcomes.