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[Q fever endocarditis and bicuspid aortic valve]
O Shovman1, J George, Y Shoenfeld
1Medial Dept. B, Chaim Sheba Medical Center, Tel Hashomer.
Abstract:
Q fever is caused by the rickettsia Coxiella burnetti, an obligate intracellular bacterium acquired by inhalation of infected dust from subclinically infected animals. Q fever may be acute or chronic; the chronic form mostly presents as endocarditis. Immunocompromised states and underlying heart disease are the most important risk factors. Usually the symptoms of Q fever endocarditis are nonspecific and diagnosis is often established very late. New criteria for diagnosis include a single blood culture positive for Coxiella burnetti, positive Q fever serology and characteristic echocardiographic studies. We describe a 49-year-old man with bicuspid aortic valve admitted with fever, weight loss and a new heart murmur. The diagnosis of Q fever endocarditis was established by positive Q fever serology, and an echocardiogram showing vegetations and valvular dysfunction. This case suggests that Q fever endocarditis should be considered in patients with "sterile" endocarditis.
Insights
Q fever endocarditis, caused by Coxiella burnetii, often presents with vague symptoms. Early consideration in "sterile" endocarditis cases improves diagnosis.
Area of Science:
- Infectious Diseases
- Cardiology
- Microbiology
Background:
- Q fever is caused by Coxiella burnetii, an intracellular bacterium transmitted via inhalation of infected animal dust.
- Chronic Q fever frequently manifests as endocarditis, with immunocompromised individuals and those with heart disease at higher risk.
- Diagnosis of Q fever endocarditis is often delayed due to nonspecific symptoms.
Observation:
- Chronic Q fever endocarditis is often diagnosed late due to nonspecific symptoms.
- Risk factors include immunocompromised states and pre-existing heart disease.
- A case of Q fever endocarditis in a 49-year-old man with a bicuspid aortic valve is presented.
Findings:
- The patient presented with fever, weight loss, and a new heart murmur.
- Diagnosis was confirmed by positive Q fever serology and echocardiographic findings of vegetations and valvular dysfunction.
- New diagnostic criteria include positive blood cultures for Coxiella burnetii, serology, and echocardiography.
Implications:
- Q fever endocarditis should be suspected in patients with culture-negative or "sterile" endocarditis.
- Timely diagnosis and treatment are crucial for managing this serious condition.
- This case highlights the importance of considering zoonotic infections in endocarditis evaluations.