Q fever endocarditis: an unusual presentation

Coxiella burnetii Endocarditis in a Patient with Systemic Lupus Erythematosus: A Case Report of a Diagnostic Challenge

Patient: Male, 43-year-old

Final Diagnosis: Q-fever endocarditis

Symptoms: Lower limb edema • shortness of breath

Medication: —

Clinical Procedure: —

Specialty: General and Internal Medicine

Life cycle of Ornithodoros rostratus (Acari: Argasidae) ticks feeding on mice under laboratory conditions

Ornithodoros rostratus Aragão is an argasid tick found in Bolivia, Paraguay, Argentina and Brazil. Only limited studies about O. rostratus have been conducted and several aspects of their life cycle differ among studies or remain unexplored. In order to better elucidate the biology of O. rostratus, the present work describes its life cycle when feeding on mice under laboratory conditions. To complete their life cycle on mice, O. rostratus goes through a larval stage, 3-6 nymphal instars (nymph 1-6) and adult male and female. Adults can be originated from nymph 3-6. Nymphs 4 with higher weight after feeding tend to originate adults. Adults originated from early instars tended to be lighter. Females tended to be heavier than males. Larvae needed on average 2.7 days to complete their blood meal whereas other instars ranged from 17.3 to 78.3 min. The capacity to ingest blood was higher in larvae and females in comparison to males. The preecdysis period ranged from 5 to 12.5 days. After one blood meal, females remain on average 15.2 ± 5.8 days laying 276.8 ± 137.2.9 eggs. Females originated from nymph 4 had similar oviposition time, egg incubation and conversion ingested blood/number of eggs produced, but presented lower initial weigh and weigh gain, generating fewer eggs. Our results added novel information on O. rostratus biology and was discussed considering the variability of argasid populations and in context with the differences about their life cycle described in previous works.

Development of a high throughput PCR to detect Coxiella burnetii and its application in a diagnostic laboratory over a 7-year period

Q fever is a worldwide zoonotic infectious disease due to Coxiella burnetii. The clinical presentation may be acute (pneumonia and/or hepatitis) or chronic (most commonly endocarditis). Diagnosis mainly relies on serology and PCR. We therefore developed a quantitative real-time PCR. We first tested blindly its performance on various clinical samples and then, when thoroughly validated, we applied it during a 7-year period for the diagnosis of both acute and persistent C. burnetii infection. Analytical sensitivity (< 10 copies/PCR) was excellent. When tested blindly on 183 samples, the specificity of the PCR was 100% (142/142) and the sensitivity was 71% (29/41). The sensitivity was 88% (7/8) on valvular samples, 69% (20/29) on blood samples and 50% (2/4) on urine samples. This new quantitative PCR was then successfully applied for the diagnosis of acute Q fever and endovascular infection due to C. burnetii, allowing the diagnosis of Q fever in six patients over a 7-year period. During a local small cluster of cases, the PCR was also applied to blood from 1355 blood donors; all were negative confirming the high specificity of this test. In conclusion, we developed a highly specific method with excellent sensitivity, which may be used on sera for the diagnosis of acute Q fever and on various samples such as sera, valvular samples, aortic specimens, bone and liver, for the diagnosis of persistent C. burnetii infection.