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[Q fever with endocarditis: clinical presentation and serologic follow-up of 21 patients].
Schweiz Med Wochenschr. 1998 Apr 04; 128(14):521-7.SM

Abstract

AIM OF THE STUDY

The purpose of this study was to analyse the clinical and serological follow-up in 21 patients with Q fever endocarditis in Switzerland from 1981 to 1993.

PATIENTS AND METHODS

Criteria for Q fever endocarditis were the following: Coxiella burnetii phase I IgG > 1 : 2560 and IgA > 1 : 20 by indirect immunofluorescence. Methods to confirm the diagnosis include immunohistochemical demonstration of C. burnetii by microscopy in valvular material (1 case) and inoculation of this material in experimental animals (10 cases). Information on clinical course of the disease, laboratory abnormalities and treatment were obtained by chart review and a questionnaire sent to physicians who requested the serological tests for Q fever.

RESULTS

The average age of the patients was 47 years (15 men and 6 women). 64% of patients had a history of environmental exposure to C. burnetii. The median time of symptomatology before diagnosis was 5 months (1-108). 19/21 patients had valvular lesions, and 2/21 vascular Dacron prosthesis. Most patients presented with fever (18/21), congestive cardiac failure (14/21), weight loss (12/21), anemia (6/19), or thrombocytopenia (6/19). All the patients required antibiotic treatment. Cardiac surgery was performed in 15/21 patients. For 10 patients the geometric mean serological follow-up included at least titers at time of diagnosis (IgG anti-phase I antibodies 1 : 27024, IgA anti-phase I antibodies 1 : 685), at the end of therapy (IgG anti-phase I antibodies 1 : 2941, IgA anti-phase I antibodies 1 : 153) and 6 months after the end of therapy (IgG anti-phase I antibodies 1 : 368, IgA anti-phase I antibodies 1 : 40). The fall in anti-phase I titers was significant. During the clinical and serological outcome (median of 60 months and 69 months respectively) there was no recurrence of endocarditis and antibody titers to C. burnetii phase I remained low. Two patients died during the observation period, one from lung cancer, while the cause of death in the other was unknown.

CONCLUSIONS

Serology is the key to Q fever diagnosis. The duration of treatment, and the values to be used to establish cure of endocarditis, are not clearly defined. During the clinical and serological outcome (median of 60 months and 69 months respectively) there was no recurrence of endocarditis and antibody titers to C. burnetii phase I remained low.

Authors+Show Affiliations

Institut Central des Hôpitaux Valaisans, Sion.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

English Abstract
Journal Article

Language

fre

PubMed ID

9592893

Citation

Duroux-Vouilloz, C, et al. "[Q Fever With Endocarditis: Clinical Presentation and Serologic Follow-up of 21 Patients]." Schweizerische Medizinische Wochenschrift, vol. 128, no. 14, 1998, pp. 521-7.
Duroux-Vouilloz C, Praz G, Francioli P, et al. [Q fever with endocarditis: clinical presentation and serologic follow-up of 21 patients]. Schweiz Med Wochenschr. 1998;128(14):521-7.
Duroux-Vouilloz, C., Praz, G., Francioli, P., & Péter, O. (1998). [Q fever with endocarditis: clinical presentation and serologic follow-up of 21 patients]. Schweizerische Medizinische Wochenschrift, 128(14), 521-7.
Duroux-Vouilloz C, et al. [Q Fever With Endocarditis: Clinical Presentation and Serologic Follow-up of 21 Patients]. Schweiz Med Wochenschr. 1998 Apr 4;128(14):521-7. PubMed PMID: 9592893.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Q fever with endocarditis: clinical presentation and serologic follow-up of 21 patients]. AU - Duroux-Vouilloz,C, AU - Praz,G, AU - Francioli,P, AU - Péter,O, PY - 1998/5/21/pubmed PY - 1998/5/21/medline PY - 1998/5/21/entrez SP - 521 EP - 7 JF - Schweizerische medizinische Wochenschrift JO - Schweiz Med Wochenschr VL - 128 IS - 14 N2 - AIM OF THE STUDY: The purpose of this study was to analyse the clinical and serological follow-up in 21 patients with Q fever endocarditis in Switzerland from 1981 to 1993. PATIENTS AND METHODS: Criteria for Q fever endocarditis were the following: Coxiella burnetii phase I IgG > 1 : 2560 and IgA > 1 : 20 by indirect immunofluorescence. Methods to confirm the diagnosis include immunohistochemical demonstration of C. burnetii by microscopy in valvular material (1 case) and inoculation of this material in experimental animals (10 cases). Information on clinical course of the disease, laboratory abnormalities and treatment were obtained by chart review and a questionnaire sent to physicians who requested the serological tests for Q fever. RESULTS: The average age of the patients was 47 years (15 men and 6 women). 64% of patients had a history of environmental exposure to C. burnetii. The median time of symptomatology before diagnosis was 5 months (1-108). 19/21 patients had valvular lesions, and 2/21 vascular Dacron prosthesis. Most patients presented with fever (18/21), congestive cardiac failure (14/21), weight loss (12/21), anemia (6/19), or thrombocytopenia (6/19). All the patients required antibiotic treatment. Cardiac surgery was performed in 15/21 patients. For 10 patients the geometric mean serological follow-up included at least titers at time of diagnosis (IgG anti-phase I antibodies 1 : 27024, IgA anti-phase I antibodies 1 : 685), at the end of therapy (IgG anti-phase I antibodies 1 : 2941, IgA anti-phase I antibodies 1 : 153) and 6 months after the end of therapy (IgG anti-phase I antibodies 1 : 368, IgA anti-phase I antibodies 1 : 40). The fall in anti-phase I titers was significant. During the clinical and serological outcome (median of 60 months and 69 months respectively) there was no recurrence of endocarditis and antibody titers to C. burnetii phase I remained low. Two patients died during the observation period, one from lung cancer, while the cause of death in the other was unknown. CONCLUSIONS: Serology is the key to Q fever diagnosis. The duration of treatment, and the values to be used to establish cure of endocarditis, are not clearly defined. During the clinical and serological outcome (median of 60 months and 69 months respectively) there was no recurrence of endocarditis and antibody titers to C. burnetii phase I remained low. SN - 0036-7672 UR - https://www.unboundmedicine.com/medline/citation/9592893/[Q_fever_with_endocarditis:_clinical_presentation_and_serologic_follow_up_of_21_patients]_ L2 - http://www.diseaseinfosearch.org/result/6127 DB - PRIME DP - Unbound Medicine ER -