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Mohamad Alahmad MA, Hammoud KA. Inpatient Q Fever Frequency Is on the Rise. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2023; 2023:4243312. [PMID: 38187214 PMCID: PMC10771919 DOI: 10.1155/2023/4243312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 01/09/2024]
Abstract
Background Q fever is a zoonotic bacterial infection caused by Coxiella burnetii that is reportable in the USA. This infection is often asymptomatic; acute infection usually manifests as a self-limited febrile illness, hepatitis, or pneumonia. Chronic infection (usually infective endocarditis) often affects patients with valvulopathy or immunosuppression. Herein, we study the inpatient frequency of Q fever in the United States. Methods We used a nationwide inpatient sample (NIS) for our retrospective cohort study to include hospitalizations with a diagnosis of Q fever between 2010 and 2019. Survey procedures were applied to accommodate for complex sampling design of NIS. Chi-square and least-square means were used for categorical and continuous variables, respectively. Jonckheere-Terpstra test was used to study the trends over the years. SAS 9.4 was used for data mining and analysis. Results A total of 2,685 hospitalizations with a diagnosis of Q fever were included, among which 451 (17%) cases had a concurrent diagnosis of infective endocarditis. The mean age of patients was 58 years, and less than a third was female. Our analysis demonstrated that infective endocarditis was the most common cardiac complication associated with Q fever and was associated with increased inpatient mortality (p value <0.001). There is a trend of an increase in cases of inpatient Q fever with or without endocarditis over the years (p value <0.05). Q fever cases were more common across the Pacific and the South Atlantic divisions. Conclusion Physicians should be aware of an increasing trend of hospitalized patients with Q fever and the significant association with infective endocarditis. Further studies are needed.
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Affiliation(s)
| | - Kassem A Hammoud
- University of Kansas Medical Center, Division of Infectious Diseases, Kansas City, KS, USA
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Goyal A, Dalia T, Bhyan P, Farhoud H, Shah Z, Vidic A. Rare case of chronic Q fever myocarditis in end stage heart failure patient: A case report. World J Cardiol 2022; 14:508-513. [PMID: 36187426 PMCID: PMC9523269 DOI: 10.4330/wjc.v14.i9.508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/30/2022] [Accepted: 08/18/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Q fever myocarditis is a rare disease manifestation of Q fever infection caused by Coxiella burnetii. It is associated with significant morbidity and mortality if left untreated. Prior studies have reported myocarditis in patients with acute Q fever. We present the first case of chronic myocarditis in an end-stage heart failure patient with chronic Q fever infection.
CASE SUMMARY A 69-year-old male was admitted with dyspnea on exertion, hypotension and bilateral lower extremity edema for a few months. He has a past medical history of ischemic cardiomyopathy with left ventricular ejection fraction of 25%, implantable cardioverter defibrillator in place, bioprosthetic aortic valve and mitral valve replacement. He continued to have shortness of breath despite diuresis along with low grade fevers. Initial infectious work up came back negative. On further questioning, the patient was found to have close contact with farm animals and the recurrent fevers prompted the work-up for Q fever. Q fever serologies and cardiac positron emission tomography confirmed the diagnosis of chronic Q fever myocarditis. He was then successfully treated with doxycycline and hydroxychloroquine for 18 mo.
CONCLUSION Chronic Q fever myocarditis, if left untreated, carries a poor prognosis. It should be kept in differentials, especially in patients with recurrent fevers and contact with farm animals.
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Affiliation(s)
- Amandeep Goyal
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS 66160, United States
| | - Tarun Dalia
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS 66160, United States
| | - Poonam Bhyan
- Department of Internal Medicine, Cape Fear Valley Hospital, Fayetteville, NC 28304, United States
| | - Hassan Farhoud
- School of Medicine, University of Kansas Medical Center, Kansas City, KS 66160, United States
| | - Zubair Shah
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS 66160, United States
| | - Andrija Vidic
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS 66160, United States
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Maljaars J, Ortega-Gutierrez S, Cho T, Shaban A. Q Fever, CNS Vasculitis, and Stroke: A Case Report. Am J Med 2020; 133:e729-e730. [PMID: 32473872 DOI: 10.1016/j.amjmed.2020.04.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 04/10/2020] [Indexed: 11/29/2022]
Affiliation(s)
| | - Santiago Ortega-Gutierrez
- Department of Neurology; Department of Neurosurgery; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City
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Elzein FE, Alsherbeeni N, Alnajashi K, Alsufyani E, Akhtar MY, Albalawi R, Albarrag AM, Kaabia N, Mehdi S, Alzahrani A, Raoult D. Ten-year experience of Q fever endocarditis in a tertiary cardiac center in Saudi Arabia. Int J Infect Dis 2019; 88:21-26. [PMID: 31382048 DOI: 10.1016/j.ijid.2019.07.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/21/2019] [Accepted: 07/29/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Q fever endocarditis (QFE) is considered rare in the Middle East, with only a few cases reported in Saudi Arabia. The aim of this study is to report on the experience of our centre on QFE. METHODS We searched the medical records for cases of QFE at our cardiac center from 2009-2018. Demographic data, clinical features, serology and echocardiography results, treatments, and outcomes were assessed. RESULTS Five hundred and two cases of infective endocarditis were detected over the 10 years period. Among the 234 patients with blood culture-negative endocarditis (BCNE), 19 (8.10%) had QFE. All patients had a previously diagnosed congenital heart disease except for one patient with rheumatic heart disease. Eleven patients had received a bovine jugular vein-related implant, e.g., a Melody valve (seven patients) or Contegra conduit (four patients). Coinfection was detected in three patients, and immunologic and embolic phenomena were observed in five patients. All patients received a combination of hydroxychloroquine and doxycycline, with good outcomes. Only two patients required surgery while on treatment. Two patients died several months after treatment; the cause of death was not identified. CONCLUSION This study indicates that Q fever exists in our population. The majority of the patients had congenital heart disease (CHD) and underwent bovine jugular vein implants. Patients with CHD are at increased risk of infective endocarditis. Bovine jugular vein implants increase the risk of infective and possibly QFE. Proper exclusion of Q fever is warranted in all BCNE and possibly in culture-positive endocarditis cases in areas endemic to Q fever. KEY POINTS We presented the largest series of Q fever endocarditis cases in Saudi Arabia. We showed that Q fever is not rare in the Middle East and suggest that it should be considered in all blood culture-negative endocarditis cases.
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Affiliation(s)
- Fatehi E Elzein
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia.
| | - Nisreen Alsherbeeni
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | | | - Eid Alsufyani
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | - M Y Akhtar
- Prince Sultan Cardiac Centre, Riyadh, Saudi Arabia
| | - Rashed Albalawi
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | | | - Naoufel Kaabia
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | - Syed Mehdi
- Prince Sultan Cardiac Centre, Riyadh, Saudi Arabia
| | | | - Didier Raoult
- Aix Marseille Université, MEPHI, IHU-Méditerranée Infection, Marseille, France; IHU-Méditerranée Infection, Marseille, France
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5
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Jacobson A, Sutthiwan P. Myocarditis: A rare manifestation of acute Q fever infection. J Cardiol Cases 2019; 20:45-48. [PMID: 31440310 DOI: 10.1016/j.jccase.2019.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/03/2019] [Accepted: 03/22/2019] [Indexed: 12/20/2022] Open
Abstract
Myocarditis is a rare disease manifestation of acute Q fever caused by infection with Coxiella burnetii, an infectious Gram-negative proteobacteria. C. burnetii has a large animal reservoir and is often transmitted to humans during animal birth. Acute Q fever has a nonspecific disease presentation leading to delayed treatment and potentially worsened clinical outcomes. We describe a case of an otherwise healthy adult man with angina, ST elevations, and positive cardiac troponins-all findings suggestive of acute coronary syndrome. Cardiac catheterization revealed no significant coronary blockages or abnormalities. On echocardiography he was found to have heart failure with reduced ejection fraction. The patient's social history included several risk factors for Q fever. Serologic testing returned positive for anti-C. burnetii antibodies, and a diagnosis of acute Q fever myocarditis was made. The patient was appropriately treated with a course of doxycycline and clinically improved. <Learning objective: Q fever has a nonspecific presentation often leading to a delayed or missed diagnosis, resulting in worsened morbidity and mortality. Patients with angina-like chest pain and risk factors for Q fever should promptly be tested for infection with C. burnetii. Cardiac magnetic resonance imaging is a useful tool to improve diagnostic accuracy, with positive serology confirming the diagnosis. Treatment includes a course of antibiotics-often doxycycline.>.
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Straily A, Dahlgren FS, Peterson A, Paddock CD. Surveillance for Q Fever Endocarditis in the United States, 1999-2015. Clin Infect Dis 2018; 65:1872-1877. [PMID: 29140515 DOI: 10.1093/cid/cix702] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 08/04/2017] [Indexed: 01/01/2023] Open
Abstract
Background Q fever is a worldwide zoonosis caused by Coxiella burnetii. In some persons, particularly those with cardiac valve disease, infection with C. burnetii can cause a life-threatening infective endocarditis. There are few descriptive analyses of Q fever endocarditis in the United States. Methods Q fever case report forms submitted during 1999-2015 were reviewed to identify reports describing endocarditis. Cases were categorized as confirmed or probable using criteria defined by the Council for State and Territorial Epidemiologists (CSTE). Demographic, laboratory, and clinical data were analyzed. Results Of 140 case report forms reporting endocarditis, 49 met the confirmed definition and 36 met the probable definition. Eighty-two percent were male and the median age was 57 years (range, 16-87 years). Sixty-seven patients (78.8%) were hospitalized, and 5 deaths (5.9%) were reported. Forty-five patients (52.9%) had a preexisting valvulopathy. Eight patients with endocarditis had phase I immunoglobulin G antibody titers >800 but did not meet the CSTE case definition for Q fever endocarditis. Conclusions These data summarize a limited set of clinical and epidemiological features of Q fever endocarditis collected through passive surveillance in the United States. Some cases of apparent Q fever endocarditis could not be classified by CSTE laboratory criteria, suggesting that comparison of phase I and phase II titers could be reexamined as a surveillance criterion. Prospective analyses of culture-negative endocarditis are needed to better assess the clinical spectrum and magnitude of Q fever endocarditis in the United States.
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Affiliation(s)
| | - F Scott Dahlgren
- Rickettsial Zoonoses Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amy Peterson
- Rickettsial Zoonoses Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christopher D Paddock
- Rickettsial Zoonoses Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
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Han X, Hsu J, Miao Q, Zhou BT, Fan HW, Xiong XL, Wen BH, Wu L, Yan XW, Fang Q, Chen W. Retrospective Examination of Q Fever Endocarditis: An Underdiagnosed Disease in the Mainland of China. Chin Med J (Engl) 2017; 130:64-70. [PMID: 28051025 PMCID: PMC5221114 DOI: 10.4103/0366-6999.196566] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background: Q fever endocarditis, a chronic illness caused by Coxiella burnetii, can be fatal if misdiagnosed or left untreated. Despite a relatively high positive rate of Q fever serology in healthy individuals in the mainland of China, very few cases of Q fever endocarditis have been reported. This study summarized cases of Q fever endocarditis among blood culture negative endocarditis (BCNE) patients and discussed factors attributing to the low diagnostic rate. Methods: We identified confirmed cases of Q fever endocarditis among 637 consecutive patients with infective endocarditis (IE) in the Peking Union Medical College Hospital between 2006 and 2016. The clinical findings for each confirmed case were recorded. BCNE patients were also examined and each BCNE patient's Q fever risk factors were identified. The risk factors and presence of Q fever serologic testing between BCNE patients suspected and unsuspected of Q fever were compared using the Chi-squared or Chi-squared with Yates’ correction for continuity. Results: Among the IE patients examined, there were 147 BCNE patients, of whom only 11 patients (7.5%) were suspected of Q fever and undergone serological testing for C. burnetii. Six out of 11 suspected cases were diagnosed as Q fever endocarditis. For the remaining136 BCNE patients, none of them was suspected of Q fever nor underwent relevant testing. Risk factors for Q fever endocarditis were comparable between suspected and unsuspected patients, with the most common risk factors being valvulopathy in both groups. However, significantly more patients had consulted the Infectious Diseases Division and undergone comprehensive diagnostic tests in the suspected group than the unsuspected group (100% vs. 63%, P = 0.03). Conclusions: Q fever endocarditis is a serious yet treatable condition. Lacking awareness of the disease may prevent BCNE patients from being identified, despite having Q fever risk factors. Increasing awareness and guideline adherence are crucial in avoiding misdiagnosing and missed diagnosing of the disease.
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Affiliation(s)
- Xiao Han
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Jeffrey Hsu
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Qi Miao
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Bao-Tong Zhou
- Department of Infection, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Hong-Wei Fan
- Department of Infection, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xiao-Lu Xiong
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, China
| | - Bo-Hai Wen
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, China
| | - Lian Wu
- Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xiao-Wei Yan
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Quan Fang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Wei Chen
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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Miranda WR, Connolly HM, Bonnichsen CR, DeSimone DC, Dearani JA, Maleszewski JJ, Greason KL, Wilson WR, Baddour LM. Prosthetic pulmonary valve and pulmonary conduit endocarditis: clinical, microbiological and echocardiographic features in adults. Eur Heart J Cardiovasc Imaging 2016; 17:936-43. [DOI: 10.1093/ehjci/jew086] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 03/31/2016] [Indexed: 01/27/2023] Open
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9
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Tattevin P, Watt G, Revest M, Arvieux C, Fournier PE. Update on blood culture-negative endocarditis. Med Mal Infect 2015; 45:1-8. [PMID: 25480453 DOI: 10.1016/j.medmal.2014.11.003] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 11/04/2014] [Indexed: 12/13/2022]
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10
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Diagnostic Dilemmas in Q Fever Endocarditis. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2014. [DOI: 10.1097/ipc.0b013e318281d8f1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Cunha BA, Wolfe LA, Gran A, Paruchuri V, Gubernikoff G. Bright spots: Q fever prosthetic valve endocarditis. Am J Med 2013; 126:1057-8. [PMID: 24135510 DOI: 10.1016/j.amjmed.2013.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 08/23/2013] [Accepted: 08/23/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Burke A Cunha
- Division of Infectious Disease, Winthrop-University Hospital, Mineola, NY; State University of New York School of Medicine, Stony Brook, NY.
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12
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DeSimone DC, Baddour LM, Lahr BD, Chung HH, Wilson WR, Steckelberg JM. Euthermic endocarditis. PLoS One 2013; 8:e80144. [PMID: 24244630 PMCID: PMC3823819 DOI: 10.1371/journal.pone.0080144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 10/07/2013] [Indexed: 12/17/2022] Open
Abstract
Background Most patients with infective endocarditis (IE) manifest fever. Comparison of endocarditis patients with and without fever, and whether the lack of fever in IE is a marker for poorer outcomes, such as demonstrated in other severe infectious diseases, have not been defined. Methods and Results Cases from the Mayo Clinic, Rochester, Minnesota, Division of Infectious Diseases IE registry, a single-center database that contains all cases of IE treated at our center. Diagnosis date between 1970 and 2006, which met the modified Duke criteria for definite endocarditis, without fever was included. There were 240 euthermic endocarditis cases included in this analysis, with 282 febrile controls selected by frequency matching on gender and decade of diagnosis. Euthermic patients had a median age of 63.6 years (±16.1) as compared to 59.0 years (±16.4) in the febrile control group (p=0.001). Median (IQR) symptom duration prior to diagnosis was 4.0 (1.0, 12.0) weeks in the euthermic group compared to 3.0 (1.0, 8.0) weeks in the febrile controls (p= 0.006). From unadjusted analyses, survival rates were 87% in euthermic cases versus 83% in febrile controls across 28-day follow-up (p=0.164), and 72% in euthermic group cases versus 69% in febrile controls across 1-year follow-up (p=0.345). Also unadjusted, the 1-year cumulative incidence rate of valve surgery was higher in euthermic cases versus febrile controls (50% vs. 39%, p= 0.004). Conclusions Patients with euthermic endocarditis are older, and lack of fever was associated with longer symptom duration and delayed diagnosis prior to IE diagnosis. Despite a higher unadjusted rate of valve surgery in euthermic patients, the result was not significant when adjusting for baseline confounders. Differences in survival rates at both 28-days and 365-days were not statistically significant between the two groups.
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Affiliation(s)
- Daniel C. DeSimone
- Infectious Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota, United States of America
- * E-mail:
| | - Larry M. Baddour
- Infectious Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota, United States of America
| | - Brian D. Lahr
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Heath H. Chung
- Infectious Diseases, John A. Burns School of Medicine, University of Hawaii, Handicap International, Honolulu, Hawaii, United States of America
| | - Walter R. Wilson
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, United States of America
| | - James M. Steckelberg
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, United States of America
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Moustafa S, Patton DJ, Ross DB, Balon Y, Alvarez N. Unexpected sequel of chronic Q-fever endocarditis. Heart Lung Circ 2013; 22:1054-5. [PMID: 23628330 DOI: 10.1016/j.hlc.2013.03.086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 03/27/2013] [Accepted: 03/31/2013] [Indexed: 10/26/2022]
Abstract
We report a patient with chronic Q-fever endocarditis who was treated with Bentall procedure on two occasions due to persistent endocarditis. A chronic pseudoaneurysm of the aortic root was discovered incidentally by cardiac magnetic resonance and computed tomography eight years post-operatively. Due to chronicity of the pseudoaneurysm and great risk of re-intervention, conservative management was recommended.
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Affiliation(s)
- Sherif Moustafa
- Adult Congenital Heart Disease Clinic, Peter Lougheed Hospital, Division of Cardiovascular Diseases, University of Calgary, Canada; Division of Cardiovascular Diseases, Prince Salman Heart Center, King Fahad Medical City, Riyadh, Saudi Arabia
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Gunn TM, Raz GM, Turek JW, Farivar RS. Cardiac Manifestations of Q Fever Infection: Case Series and a Review of the Literature. J Card Surg 2013; 28:233-7. [DOI: 10.1111/jocs.12098] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Tyler M. Gunn
- Department of Cardiothoracic Surgery; University of Iowa Carver College of Medicine; Iowa City, Iowa
| | - Guy M. Raz
- Department of Cardiothoracic Surgery; University of Iowa Carver College of Medicine; Iowa City, Iowa
| | - Joseph W. Turek
- Department of Cardiothoracic Surgery; University of Iowa Carver College of Medicine; Iowa City, Iowa
| | - Robert Saeid Farivar
- Division of Cardiothoracic Surgery; University of Pennsylvania Perelman School of Medicine; Philadelphia, Pennsylvania
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Abstract
Coxiella burnetii, the agent of Q fever, is an obligate intracellular pathogen typically associated with exposure to livestock. This organism may present with acute or chronic manifestations, the most typical chronic manifestation being endocarditis. We report a highly unusual case of Q fever endocarditis acquired in the United States marked by atypical cardiac manifestations.
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Chronic Q fever: Review of the literature and a proposal of new diagnostic criteria. J Infect 2012; 64:247-59. [DOI: 10.1016/j.jinf.2011.12.014] [Citation(s) in RCA: 135] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 12/20/2011] [Accepted: 12/20/2011] [Indexed: 12/19/2022]
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