Q fever endocarditis
- Didier Raoult, MD, PhD
Didier Raoult, MD, PhD
- Faculté de Médecine
- Aix Marseille Université
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".)
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 :To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- RISK FACTORS
- CLINICAL FEATURES
- Constitutional symptoms
- Cardiac findings
- Non-cardiac manifestations
- LABORATORY DATA
- ECHOCARDIOGRAPHIC FINDINGS
- RADIOGRAPHIC IMAGING
- EVALUATION AND DIAGNOSIS
- - Our criteria
- - Duke criteria
- Testing for C. burnetii
- - Serology
- - Polymerase chain reaction
- - Culture
- - Other methods for isolating the organism
- DIFFERENTIAL DIAGNOSIS
- Drug regimens
- Antibiotic resistance
- Monitoring treatment
- - Drug levels
- - Toxicity
- - Clinical response
- - Serologic response
- Duration of therapy
- Surgical valve replacement
- PREVENTIVE THERAPY
- ENDOCARDITIS DURING ACUTE Q FEVER
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS