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Clin Infect Dis ; 62(5): 537-44, 2016 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-26585519

RESUMO

BACKGROUND: Coxiella burnetii endocarditis is considered to be a late complication of Q fever in patients with preexisting valvular heart disease (VHD). We observed a large transient aortic vegetation in a patient with acute Q fever and high levels of IgG anticardiolipin antibodies (IgG aCL). Therefore, we sought to determine how commonly acute Q fever could cause valvular vegetations associated with antiphospholipid antibody syndrome, which would be a new clinical entity. METHODS: We performed a consecutive case series between January 2007 and April 2014 at the French National Referral Center for Q fever. Age, sex, history of VHD, immunosuppression, and IgG aCL assessed by enzyme-linked immunosorbent assay were tested as potential predictors. RESULTS: Of the 759 patients with acute Q fever and available echocardiographic results, 9 (1.2%) were considered to have acute Q fever endocarditis, none of whom had a previously known VHD. After multiple adjustment, very high IgG aCL levels (>100 immunoglobulin G-type phospholipid units; relative risk [RR], 24.9 [95% confidence interval {CI}, 4.5-140.2]; P = .002) and immunosuppression (RR, 10.1 [95% CI, 3.0-32.4]; P = .002) were independently associated with acute Q fever endocarditis. CONCLUSIONS: Antiphospholipid antibody syndrome with valvular vegetations in acute Q fever is a new clinical entity. This would suggest the value of systematically testing for C. burnetii in antiphospholipid-associated cardiac valve disease, and performing early echocardiography and antiphospholipid dosages in patients with acute Q fever.


Assuntos
Síndrome Antifosfolipídica/etiologia , Endocardite Bacteriana/etiologia , Doenças das Valvas Cardíacas/etiologia , Febre Q/complicações , Anticorpos Anticardiolipina/sangue , Síndrome Antifosfolipídica/imunologia , Coxiella burnetii , Endocardite Bacteriana/imunologia , Ensaio de Imunoadsorção Enzimática , Feminino , Seguimentos , Doenças das Valvas Cardíacas/imunologia , Doenças das Valvas Cardíacas/microbiologia , Doenças das Valvas Cardíacas/patologia , Valvas Cardíacas/patologia , Humanos , Imunoglobulina G/imunologia , Masculino , Pessoa de Meia-Idade , Gravidez , Complicações Infecciosas na Gravidez/microbiologia , Febre Q/imunologia , Resultado do Tratamento
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