RESUMO
Q fever prosthetic valve endocarditis in association with antiphospholipid antibody syndrome (APS) in systemic lupus erythematosus (SLE) has not been previously reported. Here, we report a 22-year-old Saudi female diagnosed with SLE and APS. She had mitral valve replacement with bio-prosthesis five years earlier for Libman-Sack endocarditis. She presented with two months' history of fever, cough, palpitations, and progressive shortness of breath. A transthoracic echocardiogram showed a degenerative mitral valve prosthesis with a large mass causing severe obstruction. Open heart surgery revealed multiple masses on the mitral valve. PCR from the resected tissues was positive for Coxiella burnetii DNA. Q fever serology showed phase two IgG 1:2048, phase one IgG 1:512, and IgM 1:1024. The valve was replaced with a bio-prosthesis. She was well at 12 months of follow-up.
Assuntos
Síndrome Antifosfolipídica/complicações , Bioprótese/efeitos adversos , Endocardite Bacteriana/diagnóstico , Próteses Valvulares Cardíacas/efeitos adversos , Lúpus Eritematoso Sistêmico/complicações , Febre Q/diagnóstico , Procedimentos Cirúrgicos Cardíacos , Coxiella burnetii/isolamento & purificação , DNA Bacteriano/isolamento & purificação , Ecocardiografia , Endocardite Bacteriana/cirurgia , Feminino , Implante de Prótese de Valva Cardíaca , Humanos , Valva Mitral/diagnóstico por imagem , Valva Mitral/patologia , Estenose da Valva Mitral/complicações , Estenose da Valva Mitral/cirurgia , Reação em Cadeia da Polimerase , Febre Q/cirurgia , Resultado do Tratamento , Adulto JovemAssuntos
Endocardite/complicações , Febre Q/complicações , Hemorragia Retiniana/diagnóstico por imagem , Insuficiência da Valva Aórtica , Calcinose/diagnóstico , Calcinose/microbiologia , Coxiella burnetii/isolamento & purificação , Endocardite/cirurgia , Fundo de Olho , Humanos , Masculino , Pessoa de Meia-Idade , Febre Q/cirurgia , Hemorragia Retiniana/etiologiaRESUMO
OBJECTIVE: After primary infection with Coxiella burnetii, patients may develop acute Q fever, which is a relatively mild disease. A small proportion of patients (1%-5%) develop chronic Q fever, which is accompanied by high mortality and can be manifested as infected arterial or aortic aneurysms or infected vascular prostheses. The disease can be complicated by arterial fistulas, which are often fatal if they are left untreated. We aimed to assess the cumulative incidence of arterial fistulas and mortality in patients with proven chronic Q fever. METHODS: In a retrospective, observational study, the cumulative incidence of arterial fistulas (aortoenteric, aortobronchial, aortovenous, or arteriocutaneous) in patients with proven chronic Q fever (according to the Dutch Chronic Q Fever Consensus Group criteria) was assessed. Proven chronic Q fever with a vascular focus of infection was defined as a confirmed mycotic aneurysm or infected prosthesis on imaging studies or positive result of serum polymerase chain reaction for C. burnetii in the presence of an arterial aneurysm or vascular prosthesis. RESULTS: Of 253 patients with proven chronic Q fever, 169 patients (67%) were diagnosed with a vascular focus of infection (42 of whom had a combined vascular focus and endocarditis). In total, 26 arterial fistulas were diagnosed in 25 patients (15% of patients with a vascular focus): aortoenteric (15), aortobronchial (2), aortocaval (4), and arteriocutaneous (5) fistulas (1 patient presented with both an aortocaval and an arteriocutaneous fistula). Chronic Q fever-related mortality was 60% for patients with and 21% for patients without arterial fistula (P < .0001). Primary fistulas accounted for 42% and secondary fistulas for 58%. Of patients who underwent surgical intervention for chronic Q fever-related fistula (n = 17), nine died of chronic Q fever-related causes (53%). Of patients who did not undergo any surgical intervention (n = 8), six died of chronic Q fever-related causes (75%). CONCLUSIONS: The proportion of patients with proven chronic Q fever developing primary or secondary arterial fistulas is high; 15% of patients with a vascular focus of infection develop an arterial fistula. This observation suggests that C. burnetii, the causative agent of Q fever, plays a role in the development of fistulas in these patients. Chronic Q fever-related mortality in patients with arterial fistula is very high, in both patients who undergo surgical intervention and patients who do not.
Assuntos
Aneurisma Infectado/microbiologia , Fístula Arteriovenosa/microbiologia , Fístula Brônquica/microbiologia , Fístula Brônquica/cirurgia , Fístula Cutânea/microbiologia , Endocardite Bacteriana/microbiologia , Fístula Intestinal/microbiologia , Infecções Relacionadas à Prótese/microbiologia , Febre Q/microbiologia , Idoso , Idoso de 80 Anos ou mais , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/mortalidade , Aneurisma Infectado/cirurgia , Fístula Arteriovenosa/diagnóstico , Fístula Arteriovenosa/mortalidade , Fístula Arteriovenosa/cirurgia , Fístula Brônquica/diagnóstico , Fístula Brônquica/mortalidade , Fístula Cutânea/diagnóstico , Fístula Cutânea/mortalidade , Fístula Cutânea/cirurgia , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/mortalidade , Endocardite Bacteriana/cirurgia , Feminino , Humanos , Incidência , Fístula Intestinal/diagnóstico , Fístula Intestinal/mortalidade , Fístula Intestinal/cirurgia , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Prognóstico , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/mortalidade , Infecções Relacionadas à Prótese/cirurgia , Febre Q/diagnóstico , Febre Q/mortalidade , Febre Q/cirurgia , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Fatores de TempoAssuntos
Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Procedimentos Endovasculares/métodos , Infecções Relacionadas à Prótese/cirurgia , Febre Q/cirurgia , Stents/efeitos adversos , Idoso , Aneurisma da Aorta Torácica/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Infecções Relacionadas à Prótese/microbiologia , Febre Q/microbiologia , Stents/microbiologiaRESUMO
We conducted this study to determine the risk of transmission of Q fever to health care workers (HCWs) during perioperative exposure to Coxiella burnetii-infected thoracic endovascular aneurysm stent graft. Pre-operative and 6-week post-operative phase I and II IgG Q fever antibody titers were determined in 14 staff members of an operation room. The room had a negative pressure and all the members of the surgical team wore either a fitted N-95 mask or a powered purified air respirator. Phase I and II IgG antibody titers were <1:16 for 11 of the 14 studied HCWs; 2 HCWs did not follow up at 6 weeks and 1 had a pre-exposure phase II IgG titer of 1:128 with no change 6 weeks later. We concluded that risk of transmission of C. burnetii in the operating room from infected patient to HCWs who wore appropriate personal protective equipment is low.
Assuntos
Coxiella burnetii/isolamento & purificação , Corpo Clínico Hospitalar , Exposição Ocupacional , Período Perioperatório , Febre Q/transmissão , Stents/microbiologia , Aneurisma/cirurgia , Humanos , Febre Q/cirurgia , TexasRESUMO
Q fever is a worldwide zoonosis caused by an intracellular bacillus named Coxiella burnetii (CB) and is a rare cause of vascular infections. We report a case of abdominal aortic aneurysm infected by CB with bilateral paravertebral abscesses and contiguous spondylodiscitis treated by open repair using a cryopreserved allograft and long-term antibiotic therapy by oral doxycycline and oral hydroxychloroquine for a duration of 18 months. Twenty months after the operation, the patient had no infections signs and vascular complication.
Assuntos
Aneurisma Infectado/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Bioprótese , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Coxiella burnetii/isolamento & purificação , Criopreservação , Febre Q/cirurgia , Administração Oral , Idoso de 80 Anos ou mais , Aloenxertos , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Aneurisma Infectado/transmissão , Antibacterianos/administração & dosagem , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/microbiologia , Aortografia/métodos , Doxiciclina/administração & dosagem , Esquema de Medicação , Humanos , Hidroxicloroquina/administração & dosagem , Imageamento por Ressonância Magnética , Masculino , Febre Q/diagnóstico por imagem , Febre Q/microbiologia , Febre Q/transmissão , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Coxiella burnetii vascular infections continue to be very severe diseases and no guidelines exist about their prevention. In terms of treatment, the benefit of the surgical removal of infected tissues has been suggested by 1 retrospective study.We present a case of a C burnetii abdominal aortic graft infection for which we observed a dramatic clinical and biological recovery after surgery. We thus performed a retrospective cohort study to evaluate the impact of surgery on survival and serological outcome for patients with Q fever vascular infections diagnosed in our center.Between 1986 and February 2015, 100 patients were diagnosed with Q fever vascular infections. The incidence of these infections has significantly increased over the past 5 years, in comparison with the mean annual incidence over the preceding 22 years (8.83 cases per year versus 3.14 cases per year, Pâ=â0.001). A two-and-a-half-year follow-up was available for 66 patients, of whom 18.2% died. We observed 6.5% of deaths in the group of patients who were operated upon at 2 and a half years, in comparison with 28.6% in the group which were not operated upon (Pâ=â0.02). Surgery was the only factor that had a positive impact on survival at 2 and a half years using univariate analysis [hazard ratio: 0.17 [95% CI]: [0.039-0.79]; Pâ=â0.024]. Surgery was also associated with a good serological outcome (74.1% vs 57.1% of patients, Pâ=â0.03). In the group of patients with vascular graft infections (nâ=â47), surgery had a positive impact on serological outcome at 2 and a half years (85.7% vs 42.9%, Pâ<â0.001) [hazard ratio: 0.40 [95% CI]: [0.17-098]; Pâ=â0.046] and tended to be associated with lower although not statistically significant mortality (11.1% vs 27.6% of deaths, Pâ=â0.19).Surgical treatment confers a benefit in terms of survival following C burnetii vascular infections. However, given the high mortality of these infections and their rising incidence, we propose a strategy that consists of screening for vascular graft and aneurysms in the context of primary Q fever, to decide when to start prophylactic treatment, similar to the strategy recommended for the prophylaxis of Q fever endocarditis.
Assuntos
Aneurisma da Aorta Abdominal/microbiologia , Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Torácica/microbiologia , Aneurisma da Aorta Torácica/cirurgia , Ruptura Aórtica/microbiologia , Ruptura Aórtica/cirurgia , Implante de Prótese Vascular , Prótese Vascular/microbiologia , Febre Q/prevenção & controle , Febre Q/cirurgia , Infecção da Ferida Cirúrgica/microbiologia , Infecção da Ferida Cirúrgica/cirurgia , Adulto , Aneurisma da Aorta Abdominal/mortalidade , Aneurisma da Aorta Torácica/mortalidade , Ruptura Aórtica/mortalidade , Estudos de Coortes , Endocardite Bacteriana/microbiologia , Endocardite Bacteriana/prevenção & controle , Fluordesoxiglucose F18 , Seguimentos , Humanos , Masculino , Imagem Multimodal , Tomografia por Emissão de Pósitrons , Febre Q/mortalidade , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/mortalidade , Taxa de Sobrevida , Tomografia Computadorizada por Raios XRESUMO
Q fever osteomyelitis, caused by infection with Coxiella burnetti, is rare but should be included in the differential diagnosis of children with culture-negative osteomyelitis, particularly if there is a history of contact with farm animals, and/or granulomatous change on histologic examination of a bone biopsy specimen. We describe a case of Q fever osteomyelitis in a 6-year-old boy in which a decision was made not to treat the patient with combination antimicrobial agents, balancing possible risks of recurrence against potential side effects of prolonged antibiotic treatment. The patient had undergone surgical debridement of a single lesion and was completely asymptomatic after recovery from surgery. This case suggests that a conservative approach of watchful waiting in an asymptomatic patient with chronic Q fever osteomyelitis may be warranted in select cases when close follow-up is possible.
Assuntos
Desbridamento , Osteomielite/cirurgia , Febre Q/cirurgia , Conduta Expectante , Antibacterianos/uso terapêutico , Criança , Humanos , Masculino , Osteomielite/diagnóstico , Osteomielite/microbiologia , Febre Q/diagnósticoRESUMO
OBJECTIVE: Since chronic Q fever often develops insidiously, and symptoms are not always recognized at an early stage, complications are often present at the time of diagnosis. We describe complications associated with vascular chronic Q fever as found in the largest cohort of chronic Q fever patients so far. METHODS: Patients with proven or probable chronic Q fever with a focus of infection in an aortic aneurysm or vascular graft were included in this study, using the Dutch national chronic Q fever database. RESULTS: A total of 122 patients were diagnosed with vascular chronic Q fever between April 2008 and June 2012. The infection affected a vascular graft in 62 patients (50.8%) and an aneurysm in 53 patients (43.7%). Seven patients (5.7%) had a different vascular focus. Thirty-six patients (29.5%) presented with acute complications, and 35 of these patients (97.2%) underwent surgery. Following diagnosis and start of antibiotic treatment, 26 patients (21.3%) presented with a variety of complications requiring surgical treatment during a mean follow-up of 14.1 ± 9.1 months. The overall mortality rate was 23.7%. Among these patients, mortality was associated with chronic Q fever in 18 patients (62.1%). CONCLUSIONS: The management of vascular infections with C. burnetii tends to be complicated. Diagnosis is often difficult due to asymptomatic presentation. Patients undergo challenging surgical corrections and long-term antibiotic treatment. Complication rates and mortality are high in this patient cohort.
Assuntos
Aneurisma Infectado/cirurgia , Aneurisma Aórtico/cirurgia , Prótese Vascular/efeitos adversos , Surtos de Doenças , Infecções Relacionadas à Prótese/cirurgia , Febre Q/cirurgia , Procedimentos Cirúrgicos Vasculares , Idoso , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/microbiologia , Aneurisma Infectado/mortalidade , Antibacterianos/uso terapêutico , Aneurisma Aórtico/diagnóstico , Aneurisma Aórtico/microbiologia , Aneurisma Aórtico/mortalidade , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Valor Preditivo dos Testes , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/mortalidade , Febre Q/diagnóstico , Febre Q/microbiologia , Febre Q/mortalidade , Sistema de Registros , Reoperação , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/mortalidadeRESUMO
Q fever is a bacterial infection caused by Coxiella burnetti. It can cause both acute and chronic illness. Chronic QF can present as a variety of clinical syndromes. A common and critical manifestation is endocarditis which can present atypically and is easily missed. This case describes a man who, after extensive investigation for splenomegaly and pancytopenia by several specialties, was finally diagnosed with Q fever endocarditis after unexpected aortic valve abnormalities found during elective cardiac surgery. Several factors contributed to diagnostic delay including aspects of clinical assessment and radiologic findings. Vigilance is essential for diagnosis and prompt initiation of effective treatment.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Diagnóstico Tardio , Febre Q/diagnóstico , Febre Q/cirurgia , Procedimentos Cirúrgicos Eletivos , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: The objective of our study was to analyze the efficacy of autologous superficial femoropopliteal vein reconstruction for primary aortic or aortic graft infection. METHODS: We performed a retrospective analysis of 14 patients treated for an infected aortic prosthesis or primary infected aorta between 2012 and 2014. Three patients had a primary mycotic aneurysm caused by a Salmonella or Coxiella burnetti infection. Seven patients were treated previously for aortic aneurysms with a conventional Dacron vascular prosthesis and 4 with an endovascular prosthesis. All infected prostheses were explanted via median laparotomy with subsequent debridement of the aortic aneurysm wall. Aortic reconstruction was performed with 1 or 2 superficial femoropopliteal veins, interpositioning the greater omentum when possible. The primary outcome measure was 30-day mortality. Secondary outcome measures were reoperation, operating time, amputation rate, length of intensive care unit (ICU) and hospital stay, reinfection rate, and limb edema requiring compression therapy. RESULTS: The 30-day mortality was 28%. Two patients died of an abdominal sepsis, one patient of a cerebrovascular accident and another of a hypovolemic shock. One patient died at home 2 years after surgery of unknown cause. Four patients required a reoperation. The median intraoperative blood loss was 1,500 mL (500-8000). Median operating time was 364 min (264-524). Median length of ICU stay was 3.5 days (1-47), and median hospital stay was 20 days (10-47). There were no limb amputations. Mild edema of the donor leg was documented in 2 patients. Compression stockings were not worn by any patients. Postoperative antibiotic treatment was administered for at least 6 weeks. No recurrent infections were diagnosed. CONCLUSIONS: Autologous venous reconstruction of the aorta offers advantages over other therapeutic approaches and deserves a prominent place in the treatment of the primary infected aorta or an infected aortic prosthetic graft.
Assuntos
Aneurisma Infectado/cirurgia , Aneurisma Aórtico/cirurgia , Prótese Vascular/efeitos adversos , Veia Femoral/transplante , Procedimentos de Cirurgia Plástica , Veia Poplítea/transplante , Infecções Relacionadas à Prótese/cirurgia , Febre Q/cirurgia , Infecções por Salmonella/cirurgia , Idoso , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/microbiologia , Aneurisma Infectado/mortalidade , Antibacterianos/uso terapêutico , Aneurisma Aórtico/diagnóstico , Aneurisma Aórtico/microbiologia , Aneurisma Aórtico/mortalidade , Aortografia/métodos , Autoenxertos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/mortalidade , Febre Q/diagnóstico , Febre Q/microbiologia , Febre Q/mortalidade , Procedimentos de Cirurgia Plástica/efeitos adversos , Procedimentos de Cirurgia Plástica/mortalidade , Reoperação , Estudos Retrospectivos , Fatores de Risco , Infecções por Salmonella/diagnóstico , Infecções por Salmonella/microbiologia , Infecções por Salmonella/mortalidade , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do TratamentoAssuntos
Coxiella burnetii/isolamento & purificação , Endocardite/diagnóstico , Endocardite/patologia , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/patologia , Doenças das Valvas Cardíacas/diagnóstico , Doenças das Valvas Cardíacas/patologia , Febre Q/diagnóstico , Febre Q/patologia , Idoso , Valva Aórtica/microbiologia , Valva Aórtica/patologia , Valva Aórtica/cirurgia , Técnicas Bacteriológicas , Doença da Válvula Aórtica Bicúspide , Ponte de Artéria Coronária , Endocardite/microbiologia , Endocardite/cirurgia , Cardiopatias Congênitas/microbiologia , Cardiopatias Congênitas/cirurgia , Doenças das Valvas Cardíacas/microbiologia , Doenças das Valvas Cardíacas/cirurgia , Próteses Valvulares Cardíacas , Humanos , Masculino , Microscopia , Reação em Cadeia da Polimerase , Febre Q/microbiologia , Febre Q/cirurgiaRESUMO
Untreated chronic Q fever causes a high number of complications and deaths. We present cases of chronic Q fever that were not diagnosed until after the patients underwent cardiac valve surgery. In epidemic areas, Q fever screening of valve surgery patients secures early initiation of treatment and can prevent illness and death.
Assuntos
Coxiella burnetii/isolamento & purificação , Endocardite Bacteriana/diagnóstico , Próteses Valvulares Cardíacas/microbiologia , Febre Q/diagnóstico , Idoso , Anticorpos Antibacterianos/sangue , Anticorpos Antibacterianos/imunologia , Coxiella burnetii/imunologia , Diagnóstico Tardio , Endocardite Bacteriana/complicações , Endocardite Bacteriana/imunologia , Endocardite Bacteriana/cirurgia , Feminino , Valvas Cardíacas/cirurgia , Humanos , Imunoglobulina G/sangue , Imunoglobulina G/imunologia , Masculino , Febre Q/complicações , Febre Q/imunologia , Febre Q/cirurgiaRESUMO
Coxiella burnetii is a rare cause of vascular infections. Yet, Q fever is endemic in the southern part of The Netherlands. This report describes two patients--from the southern part of The Netherlands--with infected aneurysms of the abdominal aorta caused by Coxiella burnetii. Both patients underwent surgical debridement, in situ reconstruction with a great saphenous vein spiral graft, and a transmesenteric omentumplasty. One patient fully recovered, while the other died due to ischemic complications. A multidisciplinary work-up approach to treat infected abdominal aneurysms is proposed, including adequate surgical treatment and long-term antibiotic administration.
Assuntos
Aneurisma Infectado/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Coxiella burnetii/isolamento & purificação , Procedimentos de Cirurgia Plástica , Febre Q/cirurgia , Veia Safena/transplante , Idoso , Idoso de 80 Anos ou mais , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/microbiologia , Aortografia/métodos , Colo/irrigação sanguínea , Desbridamento , Evolução Fatal , Humanos , Isquemia/etiologia , Extremidade Inferior/irrigação sanguínea , Masculino , Febre Q/diagnóstico por imagem , Febre Q/microbiologia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Chronic Q fever infections, caused by Coxiella burnetii, are associated with cardiovascular complications, mainly endocarditis and vascular (graft) infections. We report a case of a patient with a C. burnetii infected thoracic aorta graft treated initially in a conservative way. However, surgical excision of the infected graft was eventually necessary. This case report highlights the challenges regarding the treatment of patients with chronic vascular C. burnetii infections. In the absence of practical guidelines, treatment is tailored to the individual patient. Furthermore, we want to emphasize the need to include chronic Q fever in the differential diagnosis in patients with culture negative aortitis, especially in the regions with Q fever epidemics in the recent past.
Assuntos
Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Prótese Vascular/efeitos adversos , Infecções Relacionadas à Prótese/cirurgia , Febre Q/cirurgia , Prótese Vascular/microbiologia , Implante de Prótese Vascular/instrumentação , Doença Crônica , Feminino , Humanos , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/diagnóstico , Febre Q/diagnóstico , ReoperaçãoRESUMO
BACKGROUND: Prosthetic valve endocarditis (PVE) is a serious complication of valve surgery. AIM: The aim of this study is to determine the diagnostic and therapeutic management for PVE. METHODS: It's a retrospective study about 14 cases of PVE operated in the department of cardiovascular surgery of la Rabta hospital between January 1996 and December 2006. RESULTS: In two cases, surgery was performed emergent, in the remnant cases surgery was elective. The coagulase-negative staphylococcus (CNS) is the predominant cause of these PVE.Surgery consisted on seven mitral prosthesis replacements and seven aortic prosthesis replacements.Hospital mortality was 50%. CONCLUSION: In conclusion attention should be made to prevent endocarditis when possible. In case of PVE, an early diagnosis a leads to earlier application of appropriate therapies and improved outcome.
Assuntos
Valva Aórtica/microbiologia , Endocardite Bacteriana/microbiologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Valva Mitral/microbiologia , Infecções Relacionadas à Prótese/microbiologia , Febre Q/complicações , Infecções Estafilocócicas/complicações , Adulto , Valva Aórtica/patologia , Valva Aórtica/cirurgia , Endocardite Bacteriana/mortalidade , Endocardite Bacteriana/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/patologia , Valva Mitral/cirurgia , Falha de Prótese , Infecções Relacionadas à Prótese/mortalidade , Infecções Relacionadas à Prótese/cirurgia , Febre Q/mortalidade , Febre Q/cirurgia , Reoperação , Estudos Retrospectivos , Infecções Estafilocócicas/mortalidade , Infecções Estafilocócicas/cirurgiaAssuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Prótese Vascular/efeitos adversos , Tomografia por Emissão de Pósitrons , Infecções Relacionadas à Prótese/diagnóstico , Febre Q/diagnóstico , Tomografia Computadorizada por Raios X , Antibacterianos/uso terapêutico , Doença Crônica , Terapia Combinada , Remoção de Dispositivo , Fluordesoxiglucose F18 , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/cirurgia , Febre Q/tratamento farmacológico , Febre Q/cirurgia , Compostos Radiofarmacêuticos , Sensibilidade e Especificidade , Resultado do TratamentoAssuntos
Endocardite/microbiologia , Endocardite/cirurgia , Febre Q/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND AND AIM OF THE STUDY: Q fever endocarditis caused by Coxiella burnetii is the most important etiology of negative blood culture endocarditis. Without specific clinical findings, diagnosis is difficult and prevalence of this life-threatening disease is underestimated. METHODS: Q fever endocarditis was assessed in 19 patients (15 men, four women; age range: 36-79 years) by evaluating clinical and echocardiographic criteria and specific serology. All patients had evidence of pre-existing valvular disease, and 10 had a valvular prosthesis. Diagnosis was assessed in: the presence of unexplained fever (n = 5), heart failure with valvular dysfunction (n = 10), hemolysis (n = 1), glomerulonephritis (n = 1) and stroke (n = 2). A late diagnosis was made in eight patients, either during or after surgery. RESULTS: In all cases, usual blood cultures remained negative, despite specific serology being positive. Transthoracic and transesophageal echocardiography were conclusive in only six cases (four vegetations, two periannular abscesses). Surgery was indicated in 15 patients for heart failure or valvular dysfunction (n = 12), hemolysis (n = 1) and periannular abscess (n = 2). Intraoperative findings were suggestive of endocarditis in seven cases; valvular cultures were positive in 92% of cases. All patients were treated with combined doxycycline/ hydrochloroquine or quinolone, for a mean of 24 months (range: 6-60 months). Mean follow up was 40 months (range: 6-144 months). Two patients died from heart failure, one patient was lost to follow up, and 16 patients had no late relapses. CONCLUSION: Q fever is an underestimated cause of endocardititis, and early diagnosis is the key to good prognosis. The need for systematic serologic examination in case of valvular dysfunction, with or without endocarditis symptoms, is emphasized.
Assuntos
Endocardite Bacteriana/microbiologia , Endocardite Bacteriana/cirurgia , Febre Q/diagnóstico , Adulto , Idoso , Endocardite Bacteriana/diagnóstico , Feminino , Doenças das Valvas Cardíacas , Próteses Valvulares Cardíacas , Humanos , Masculino , Pessoa de Meia-Idade , Febre Q/cirurgia , Estudos Retrospectivos , Fatores de RiscoRESUMO
PURPOSE: Cardiac valves that were resected from patients with Q fever endocarditis were examined by immunohistologic methods to correlate the presence of Coxiella burnetii in the valves with the histopathologic, serologic, microbiologic, and clinical findings. PATIENTS: Seventeen patients with serologic and microbiologic or clinical evidence of Q fever endocarditis who presented with cardiac failure secondary to valvular dysfunction and required valve replacement surgery were selected from the clinical records of the Unité des Rickettsies, Marseille, France. METHODS: Clinical data were collected by questionnaire. Serologic characterization was performed by indirect immunofluorescent antibody testing; shell vial cultivation of C burnetii was performed from resected valves and blood when available; and pathologic and immunohistologic testing for localization of C burnetti in resected valves were performed by standard methods using both polyclonal and monoclonal C burnetti antibodies. RESULTS: Demographic and clinical findings were typical of patients with Q fever endocarditis. Pure chronic inflammation or mixtures of acute and chronic inflammation were the most frequent inflammatory patterns present and were associated with fibrin deposition, necrosis, and fibrosis. Well-formed granulomas were not present, but the granulomatous inflammation observed in 6 of these 17 patients was associated with foreign body reactions or with valvular calcifications secondary to preexisting valvular damage and could not be directly attributed to infection. C burnetii were present nearly exclusively in macrophages in sites of inflammation and valvular injury and only in the vegetations. Immunohistologic results confirmed the valve culture results in 10 of 14 cases. CONCLUSION: The pathologic findings in the valves of patients with Q fever endocarditis are nonspecific. The presence of empty or foamy macrophages is suggestive of infection by C burnetii; however, definitive identification rests upon the demonstration of the organism in the tissue by immunohistology. Q fever endocarditis probably results from infection of previously damaged heart valves. The finding of the absence of granulomas in these cases contrasts with the pathologic findings in patients with acute, self-limited Q fever and suggests an aberrant host immune response that permits persistence of the bacterium and chronic, prolonged valvular infection and injury. The pathologic findings and distribution of C burnetii in the damaged valve tissues explain the clinical findings of valve failure and occasional embolic episodes, as well as the frequent ability to isolate C burnetii from the peripheral blood of infected patients. Immunohistology may be a valuable diagnostic tool in places where serology and culture are not available.