UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Q fever endocarditis

Author
Didier Raoult, MD, PhD
Section Editor
Stephen B Calderwood, MD
Deputy Editor
Jennifer Mitty, MD, MPH

INTRODUCTION

Q fever results from infection with Coxiella burnetii, a Proteobacteria that is mostly spread through aerosol transmission from infected animals and is found in most countries throughout the world. Q fever can present as an acute or more chronic disease.

Persistent localized infections (eg, endocarditis, infection of aneurysms or vascular grafts, bone and joint infections) can develop in a patient after symptomatic acute Q fever or following asymptomatic infection. Endocarditis, which is the most common manifestation among those with persistent infection, can be severe and even fatal. However, diagnosing Q fever endocarditis is difficult and primarily relies upon nonspecific cardiac findings, the presence of peripheral manifestations (eg, liver, kidney, and splenic involvement), the results of serologic or molecular tests, and/or the findings on imaging studies.

This topic reviews the diagnosis and treatment of patients with endocarditis associated with persistent Q fever infection. Discussions of the clinical manifestations, diagnosis, and treatment of acute Q fever (including endocarditis associated with acute infection), as well as an overview of culture-negative endocarditis, are found elsewhere. (See "Clinical manifestations and diagnosis of Q fever" and "Treatment and prevention of Q fever" and "Epidemiology, microbiology, and diagnosis of culture-negative endocarditis".)

RISK FACTORS

Most cases of subacute or chronic endocarditis secondary to C. burnetii develop between two months and two years following acute Q fever. However, only 20 to 40 percent of patients who develop endocarditis have symptoms of acute infection. (See "Clinical manifestations and diagnosis of Q fever", section on 'Acute infection'.)

Q fever endocarditis occurs primarily in men over the age of 40, and in those who are immunocompromised, pregnant, and/or have underlying valvular damage [1-6]. This was illustrated in a retrospective study of 302 patients diagnosed with acute Q fever, which noted the following [2]:

                                

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Fri Apr 29 00:00:00 GMT 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Raoult D, Marrie T. Q fever. Clin Infect Dis 1995; 20:489.
  2. Fenollar F, Fournier PE, Carrieri MP, et al. Risks factors and prevention of Q fever endocarditis. Clin Infect Dis 2001; 33:312.
  3. Maurin M, Raoult D. Q fever. Clin Microbiol Rev 1999; 12:518.
  4. Stein A, Raoult D. Q fever endocarditis. Eur Heart J 1995; 16 Suppl B:19.
  5. Million M, Walter G, Thuny F, et al. Evolution from acute Q fever to endocarditis is associated with underlying valvulopathy and age and can be prevented by prolonged antibiotic treatment. Clin Infect Dis 2013; 57:836.
  6. Anderson A, Bijlmer H, Fournier PE, et al. Diagnosis and management of Q fever--United States, 2013: recommendations from CDC and the Q Fever Working Group. MMWR Recomm Rep 2013; 62:1.
  7. Houpikian P, Habib G, Mesana T, Raoult D. Changing clinical presentation of Q fever endocarditis. Clin Infect Dis 2002; 34:E28.
  8. Million M, Thuny F, Richet H, Raoult D. Long-term outcome of Q fever endocarditis: a 26-year personal survey. Lancet Infect Dis 2010; 10:527.
  9. Raoult D, Etienne J, Massip P, et al. Q fever endocarditis in the south of France. J Infect Dis 1987; 155:570.
  10. Brouqui P, Dupont HT, Drancourt M, et al. Chronic Q fever. Ninety-two cases from France, including 27 cases without endocarditis. Arch Intern Med 1993; 153:642.
  11. Levy P, Raoult D, Razongles JJ. Q-fever and autoimmunity. Eur J Epidemiol 1989; 5:447.
  12. Million M, Walter G, Bardin N, et al. Immunoglobulin G anticardiolipin antibodies and progression to Q fever endocarditis. Clin Infect Dis 2013; 57:57.
  13. Lepidi H, Houpikian P, Liang Z, Raoult D. Cardiac valves in patients with Q fever endocarditis: microbiological, molecular, and histologic studies. J Infect Dis 2003; 187:1097.
  14. Barten DG, Delsing CE, Keijmel SP, et al. Localizing chronic Q fever: a challenging query. BMC Infect Dis 2013; 13:413.
  15. Wang SX, Zhang XC, Wang SY, et al. (18)F-FDG PET/CT localized valvular infection in chronic Q fever endocarditis. J Nucl Cardiol 2015; 22:1320.
  16. Chieng D, Janssen J, Benson S, et al. 18-FDG PET/ CT Scan in the Diagnosis and Follow-up of Chronic Q fever Aortic Valve Endocarditis. Heart Lung Circ 2016; 25:e17.
  17. Raoult D, Tissot-Dupont H, Foucault C, et al. Q fever 1985-1998. Clinical and epidemiologic features of 1,383 infections. Medicine (Baltimore) 2000; 79:109.
  18. Raoult D. Chronic Q fever: expert opinion versus literature analysis and consensus. J Infect 2012; 65:102.
  19. Li JS, Sexton DJ, Mick N, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis 2000; 30:633.
  20. Fournier PE, Casalta JP, Habib G, et al. Modification of the diagnostic criteria proposed by the Duke Endocarditis Service to permit improved diagnosis of Q fever endocarditis. Am J Med 1996; 100:629.
  21. Edouard S, Million M, Lepidi H, et al. Persistence of DNA in a cured patient and positive culture in cases with low antibody levels bring into question diagnosis of Q fever endocarditis. J Clin Microbiol 2013; 51:3012.
  22. Rolain JM, Mallet MN, Raoult D. Correlation between serum doxycycline concentrations and serologic evolution in patients with Coxiella burnetii endocarditis. J Infect Dis 2003; 188:1322.
  23. Mühlemann K, Matter L, Meyer B, Schopfer K. Isolation of Coxiella burnetii from heart valves of patients treated for Q fever endocarditis. J Clin Microbiol 1995; 33:428.
  24. Brouqui P, Dumler JS, Raoult D. Immunohistologic demonstration of Coxiella burnetii in the valves of patients with Q fever endocarditis. Am J Med 1994; 97:451.
  25. Hoen B, Selton-Suty C, Lacassin F, et al. Infective endocarditis in patients with negative blood cultures: analysis of 88 cases from a one-year nationwide survey in France. Clin Infect Dis 1995; 20:501.
  26. Houpikian P, Raoult D. Blood culture-negative endocarditis in a reference center: etiologic diagnosis of 348 cases. Medicine (Baltimore) 2005; 84:162.
  27. Raoult D, Houpikian P, Tissot Dupont H, et al. Treatment of Q fever endocarditis: comparison of 2 regimens containing doxycycline and ofloxacin or hydroxychloroquine. Arch Intern Med 1999; 159:167.
  28. Rolain JM, Boulos A, Mallet MN, Raoult D. Correlation between ratio of serum doxycycline concentration to MIC and rapid decline of antibody levels during treatment of Q fever endocarditis. Antimicrob Agents Chemother 2005; 49:2673.
  29. Fournier PE, Marrie TJ, Raoult D. Diagnosis of Q fever. J Clin Microbiol 1998; 36:1823.
  30. Raoult D. Treatment of Q fever. Antimicrob Agents Chemother 1993; 37:1733.
  31. Million M, Thuny F, Bardin N, et al. Antiphospholipid Antibody Syndrome With Valvular Vegetations in Acute Q Fever. Clin Infect Dis 2016; 62:537.
  32. Million M, Raoult D. The pathogenesis of the antiphospholipid syndrome. N Engl J Med 2013; 368:2335.