1
|
Price C, Smith S, Stewart J, Palesy T, Corbitt M, Galappaththy C, Hanson J. Increased recognition of Q fever aortitis as a chronic manifestation of Q fever in tropical North Queensland, Australia. Eur J Clin Microbiol Infect Dis 2023; 42:1537-1541. [PMID: 37882919 PMCID: PMC10651697 DOI: 10.1007/s10096-023-04687-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/16/2023] [Indexed: 10/27/2023]
Abstract
Aortitis is a life-threatening, manifestation of chronic Q fever. We report a series of 5 patients with Q fever aortitis who have presented to our hospital in tropical Australia since 2019. All diagnoses were confirmed with polymerase chain reaction (PCR) testing of aortic tissue. Only one had a previous diagnosis of acute Q fever, and none had classical high-risk exposures that might increase clinical suspicion for the infection. All patients underwent surgery: one died and 3 had significant complications. Q fever aortitis may be underdiagnosed; clinicians should consider testing for Coxiella burnetii in people with aortic pathology in endemic areas.
Collapse
Affiliation(s)
- Cody Price
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia
| | - Simon Smith
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia
| | - James Stewart
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia
| | - Tom Palesy
- Department of Surgery, Cairns Hospital, Cairns, Queensland, Australia
| | - Matthew Corbitt
- Department of Surgery, Cairns Hospital, Cairns, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | | | - Josh Hanson
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia.
- Kirby Institute, University of New South Wales, Sydney, Level 6, Wallace Wurth Building High Street, Kensington, New South Wales, 2052, Australia.
| |
Collapse
|
2
|
Azouzi F, Olagne L, Edouard S, Cammilleri S, Magnan PE, Fournier PE, Million M. Coxiella burnetii Femoro-Popliteal Bypass Infection: A Case Report. Microorganisms 2023; 11:2146. [PMID: 37763990 PMCID: PMC10538191 DOI: 10.3390/microorganisms11092146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/09/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023] Open
Abstract
Cardiovascular infections are the most severe and potentially lethal among the persistent focalized Coxiella burnetii infections. While aortic infections on aneurysms or prostheses are well-known, with specific complications (risk of fatal rupture), new non-aortic vascular infections are increasingly being described thanks to the emerging use of 18-fluorodeoxyglucose positron emission tomography (18F-FDG PET-scan). Here, we describe an infection of a femoro-popliteal bypass that would not have been diagnosed without the use of PET-scan. It is well-known that vascular prosthetic material is a site favorable for bacterial persistence, but the description of unusual anatomical sites, outside the heart or aorta, should raise the clinicians' awareness and generalize the indications for PET-scan, with careful inclusion of the upper and lower limbs (not included in PET-scan for cancer), particularly in the presence of vascular prostheses. Future studies will be needed to precisely determine their optimal management.
Collapse
Affiliation(s)
- Farah Azouzi
- Laboratoire de Microbiologie CHU Sahloul Sousse Tunisie, LR20SP06, Faculté de Médecine de Sousse Tunisie, Université de Sousse, Sousse 4003, Tunisia;
| | - Louis Olagne
- Service de Médecine Interne, Centre Hospitalier Universitaire Gabriel-Montpied, 63000 Clermont-Ferrand, France;
| | - Sophie Edouard
- UMR MEPHI, Institut Hospitalo-Universitaire Méditerranée Infection, Institut de la Recherche pour le Développement, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, 13005 Marseille, France;
- French Reference Center for Rickettsioses, Q Fever and Bartonelloses, Institut Hospitalo-Universitaire Méditerranée Infection, 13005 Marseille, France;
| | - Serge Cammilleri
- Service de Médecine Nucléaire Hôpital de la Timone, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France;
| | - Pierre-Edouard Magnan
- Service de Chirurgie Vasculaire, Hôpital Timone, Assistance Publique-Hôpitaux de Marseille, 13385 Marseille, France;
| | - Pierre-Edouard Fournier
- French Reference Center for Rickettsioses, Q Fever and Bartonelloses, Institut Hospitalo-Universitaire Méditerranée Infection, 13005 Marseille, France;
- UMR VITROME, Institut Hospitalo-Universitaire Méditerranée-Infection, Institut de la Recherche pour le Développement, Service de Santé des Armées, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, 13005 Marseille, France
| | - Matthieu Million
- UMR MEPHI, Institut Hospitalo-Universitaire Méditerranée Infection, Institut de la Recherche pour le Développement, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, 13005 Marseille, France;
- French Reference Center for Rickettsioses, Q Fever and Bartonelloses, Institut Hospitalo-Universitaire Méditerranée Infection, 13005 Marseille, France;
| |
Collapse
|
3
|
Sabourin E, Podglajen I, Fournier PE, Mainardi JL. Clinical and biological diagnosis and follow-up of patients treated for endovascular infections due to Coxiellaburnetii. J Infect Chemother 2023; 29:371-374. [PMID: 36584815 DOI: 10.1016/j.jiac.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/01/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022]
Abstract
The objective of this study was to evaluate the effectiveness of the recommended treatment for endovascular infections due to Coxiella burnetii. This single-center retrospective study was conducted in 13 patients with endovascular infection due to C. burnetii between January 2001 and December 2020 for a definite or possible endovascular infection due to C. burnetii with a minimum follow-up of 18 months post-infection. Clinical and biological data, including serology, blood and tissue PCR results, doxycycline and hydroxychloroquine assays were collected. Among the 13 patients, 11 had endocarditis (8 definite and 3 possible) and 2 had a vascular infection. At the time of diagnosis, fever was present in only 46% of cases. In case of endocarditis, 73% of patients had a pathological echocardiography. Biologically, the CRP level was low (52 mg/l ± 44). Autoimmune antibodies (antinuclear factor, neutrophil anticytoplasm) were present in 23% of patients. At the time of diagnosis, tissue PCR was very sensitive (100%) unlike blood or serum (29%). Blood levels of doxycycline and hydroxychloroquine were within expected values. Only one patient experienced treatment failure at two years, requiring surgery. For the 7 patients whose phase I IgG titres fell below 1/800, a minimum of 18 months of treatment was necessary. In the long term, the clinical and biological cure was 100% and 92% respectively, underlining the importance of monitoring the serum dosages of doxycycline and hydroxychloroquine. Given its sensitivity, tissue PCR could be added to the major Duke criteria.
Collapse
Affiliation(s)
- Estelle Sabourin
- Service de Microbiologie, Hôpital Européen Georges Pompidou, APHP-Centre, Université Paris Cité, Paris, France
| | - Isabelle Podglajen
- Service de Microbiologie, Hôpital Européen Georges Pompidou, APHP-Centre, Université Paris Cité, Paris, France
| | - Pierre-Edouard Fournier
- Centre National de Référence des Rickettsia, Coxiella et Bartonella, IHU Mediterranée-Infection, Marseille, France
| | - Jean-Luc Mainardi
- Service de Microbiologie, Hôpital Européen Georges Pompidou, APHP-Centre, Université Paris Cité, Paris, France.
| |
Collapse
|
4
|
Rodríguez-Fernández M, Gómez RE, Trigo-Rodríguez M, Castro C, Pérez-Crespo PM, Herrero R, León EM, Bernal S, Corzo JE, Merchante N. High incidence of asymptomatic phase I IgG seroconversion after acute Q fever episode: implications for chronic Q fever diagnosis. Clin Infect Dis 2021; 74:2122-2128. [PMID: 34554229 DOI: 10.1093/cid/ciab843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The aim of this study was to describe the natural history of acute Q fever, including its clinical and serological evolution and progression to chronic Q fever. METHODS Observational cohort study (January 2011-September 2020) performed at Valme University Hospital (Seville, Spain). Inclusion criteria: 1) Patients over the age of eighteen; 2) Acute Q fever diagnosis, defined as suggestive symptoms in the presence of phase II IgG titer > 1:256; 3) At least 6 months follow-up after the acute Q fever episode. The incidence of seroconversion to a chronic Q fever serological pattern, defined as phase I IgG titers ≥ 1:1024 six months after acute Q fever diagnosis, was assessed. RESULTS During the study period, 117 patients were included. Thirty-four (29%) patients showed phase I IgG titers ≥ 1:1024 six months after acute Q fever diagnosis. All patients with classic serologic criteria for chronic Q fever diagnosis remained asymptomatic despite no specific treatment, with a median (Q1-Q3) follow-up of 26.5 (14-44) months in this subgroup. No cases of Q fever endocarditis neither other persistent focalized infection forms were observed during the study period. CONCLUSIONS A significant proportion of acute Q fever patients develops classic serologic criteria for chronic Q fever diagnosis in the absence of additional data of chronic Q fever. Consequently, phase I IgG cutoff titer > 1:800 should not be used as a criterion to consider such a diagnosis. The incidence of persistent focalized infection forms after acute Q fever is extremely low and does not justify the use of prophylaxis strategies.
Collapse
Affiliation(s)
- Miguel Rodríguez-Fernández
- Unidad de Enfermedades Infecciosas y Microbiología. Hospital Universitario de Valme. Instituto de Biomedicina de Sevilla (IBiS). Universidad de Sevilla. Sevilla, Spain
| | - Reinaldo Espíndola Gómez
- Unidad de Enfermedades Infecciosas y Microbiología. Hospital Universitario de Valme. Instituto de Biomedicina de Sevilla (IBiS). Universidad de Sevilla. Sevilla, Spain
| | - Marta Trigo-Rodríguez
- Unidad de Enfermedades Infecciosas y Microbiología. Hospital Universitario de Valme. Instituto de Biomedicina de Sevilla (IBiS). Universidad de Sevilla. Sevilla, Spain
| | - Carmen Castro
- Unidad de Enfermedades Infecciosas y Microbiología. Hospital Universitario de Valme. Instituto de Biomedicina de Sevilla (IBiS). Universidad de Sevilla. Sevilla, Spain
| | - Pedro Martínez Pérez-Crespo
- Unidad de Enfermedades Infecciosas y Microbiología. Hospital Universitario de Valme. Instituto de Biomedicina de Sevilla (IBiS). Universidad de Sevilla. Sevilla, Spain
| | - Rocío Herrero
- Unidad de Enfermedades Infecciosas y Microbiología. Hospital Universitario de Valme. Instituto de Biomedicina de Sevilla (IBiS). Universidad de Sevilla. Sevilla, Spain
| | - Eva M León
- Unidad de Enfermedades Infecciosas y Microbiología. Hospital Universitario de Valme. Instituto de Biomedicina de Sevilla (IBiS). Universidad de Sevilla. Sevilla, Spain
| | - Samuel Bernal
- Unidad de Enfermedades Infecciosas y Microbiología. Hospital Universitario de Valme. Instituto de Biomedicina de Sevilla (IBiS). Universidad de Sevilla. Sevilla, Spain
| | - Juan E Corzo
- Unidad de Enfermedades Infecciosas y Microbiología. Hospital Universitario de Valme. Instituto de Biomedicina de Sevilla (IBiS). Universidad de Sevilla. Sevilla, Spain
| | - Nicolás Merchante
- Unidad de Enfermedades Infecciosas y Microbiología. Hospital Universitario de Valme. Instituto de Biomedicina de Sevilla (IBiS). Universidad de Sevilla. Sevilla, Spain
| |
Collapse
|
5
|
Lima PN, Carvalho R, Constancio V, Silva JC, Nunes C, Silva E, Goncalves A, Fonseca M, Antunes LF. Abdominal Aortic Aneurysms and Q Fever: An Odd Connection to Keep in Mind. J Med Cases 2021; 12:377-379. [PMID: 34527110 PMCID: PMC8425816 DOI: 10.14740/jmc3760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/13/2021] [Indexed: 11/11/2022] Open
Abstract
Abdominal aortic aneurysms (AAAs) secondary to Coxiella burnetii infections are rare but carry important implications. The diagnosis is difficult due to unspecific symptoms. To the authors' knowledge, this is the first AAA caused by chronic Q fever treated with an endoprosthesis.
Collapse
Affiliation(s)
- Pedro Novais Lima
- Angiology and Vascular Surgery Department, Centro Hospitalar e Universitario de Coimbra, Praceta Professor Mota Pinto, 3004-561 Coimbra, Portugal
| | - Ruben Carvalho
- Infectious Diseases Department, Centro Hospitalar e Universitario de Coimbra, Praceta Professor Mota Pinto, 3004-561 Coimbra, Portugal
| | - Vania Constancio
- Angiology and Vascular Surgery Department, Centro Hospitalar e Universitario de Coimbra, Praceta Professor Mota Pinto, 3004-561 Coimbra, Portugal
| | - Joana Cruz Silva
- Angiology and Vascular Surgery Department, Centro Hospitalar e Universitario de Coimbra, Praceta Professor Mota Pinto, 3004-561 Coimbra, Portugal
| | - Celso Nunes
- Angiology and Vascular Surgery Department, Centro Hospitalar e Universitario de Coimbra, Praceta Professor Mota Pinto, 3004-561 Coimbra, Portugal
| | - Eduardo Silva
- Angiology and Vascular Surgery Department, Centro Hospitalar e Universitario de Coimbra, Praceta Professor Mota Pinto, 3004-561 Coimbra, Portugal
| | - Anabela Goncalves
- Angiology and Vascular Surgery Department, Centro Hospitalar e Universitario de Coimbra, Praceta Professor Mota Pinto, 3004-561 Coimbra, Portugal
| | - Manuel Fonseca
- Angiology and Vascular Surgery Department, Centro Hospitalar e Universitario de Coimbra, Praceta Professor Mota Pinto, 3004-561 Coimbra, Portugal
| | - Luis F Antunes
- Angiology and Vascular Surgery Department, Centro Hospitalar e Universitario de Coimbra, Praceta Professor Mota Pinto, 3004-561 Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Rua Larga 2, 3000-370 Coimbra, Portugal
| |
Collapse
|
6
|
Kobayashi T, Casado Castillo F, Barker JH, Herwaldt L. Coxiella burnetii vascular graft infection. IDCases 2021; 25:e01230. [PMID: 34381690 PMCID: PMC8335630 DOI: 10.1016/j.idcr.2021.e01230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 07/20/2021] [Accepted: 07/20/2021] [Indexed: 11/19/2022] Open
Abstract
Q fever, a zoonotic infection caused by Coxiella burnetii, can present with a wide spectrum of clinical manifestations. The organism is typically transmitted from sheep, goats, or cattle to humans via contaminated aerosols. On average, 1–5% of patients with acute Q fever will develop chronic infection months to decades after their primary infections. We report a case of a chronic vascular graft infection due to Coxiella burnetii in a 61-year-old man without direct exposure to animals who presented with recurrent fever. Indium-111-labeled white blood cell scan with single-emission positron computed tomography demonstrated findings suggesting a graft infection. C. burnetii phase I and phase II IgG antibody titers were > 1:32,768 and polymerase chain reaction performed on the explanted graft was positive for C. burnetii. Q fever should be considered in the differential diagnosis of vascular infections in patients who have a pre-existing lesion such as an aneurysm, or vascular prosthesis even in the absence of a history of direct animal exposure.
Collapse
|
7
|
Sivabalan P, Visvalingam R, Grey V, Blazak J, Henderson A, Norton R. Utility of positron emission tomography imaging in the diagnosis of chronic Q fever: A Systematic Review. J Med Imaging Radiat Oncol 2021; 65:694-709. [PMID: 34056851 DOI: 10.1111/1754-9485.13244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 04/29/2021] [Indexed: 11/28/2022]
Abstract
Chronic Q fever is a diagnostic challenge. Diagnosis relies on serology and/or the detection of DNA from blood or tissue samples. PET-CT identifies tissues with increased glucose metabolism, thus identifying foci of inflammation. Our aim was to review the existing literature on the use of PET-CT to help diagnose chronic Q fever. A literature search was conducted in PubMed and Google Scholar to ascertain publications that included the terms 'Positron Emission Tomography' and 'PET CT' in combination with subheadings 'chronic Q fever' and 'Coxiella burnetii' within the search. To broaden our search retrieval, we used the terms 'chronic Q fever' and 'PET-CT'. Published literature up to 16th April 2020 was included. 274 articles were initially identified. Post-exclusion criteria, 46 articles were included. Amongst case reports and series, the most frequent focus of infection was vascular, followed by musculoskeletal then cardiac. 79.5% of patients had a focus detected with 55.3% of these having proven infected prosthetic devices. Amongst the retrospective and prospective studies, a total of 394 positive sites of foci were identified with 186 negative cases. Some had follow-up scans (53), with 75.5% showing improvement or resolution. Average timeframe for documented radiological resolution post-initiating treatment was 8.86 months. PET-CT is a useful tool in the management of chronic Q fever. Knowledge of a precise focus enables for directed surgical management helping reduce microbial burden, preventing future complications. Radiological resolution of infection can give clinicians reassurance on whether antimicrobial therapy can be ceased earlier, potentially limiting side effects.
Collapse
Affiliation(s)
- Pirathaban Sivabalan
- Department of Infectious Diseases, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.,Pathology Queensland, Townsville University Hospital, Douglas, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Rozanne Visvalingam
- Department of Radiology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Victoria Grey
- Department of Infectious Diseases, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - John Blazak
- Department of Radiology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
| | - Andrew Henderson
- Department of Infectious Diseases, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Robert Norton
- Pathology Queensland, Townsville University Hospital, Douglas, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
8
|
Coxiella Endocarditis as the Cause of Recurrent Fever and Brain Abscess in a Patient with Complex Congenital Heart Disease: A Case Report and Literature Review. Case Rep Infect Dis 2020; 2020:7894574. [PMID: 32670644 PMCID: PMC7333052 DOI: 10.1155/2020/7894574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 03/16/2020] [Accepted: 03/30/2020] [Indexed: 12/12/2022] Open
Abstract
Introduction Blood culture-negative infective endocarditis (BCNIE) can present subtly and is associated with a diagnostic delay leading to increased morbidity and mortality. Case Report. We present the case of an 18-year-old male with a history of complex congenital heart disease and 3-year intermittent episodes of fever of unknown origin, who was referred to our hospital for upper and lower extremity focal seizures. Laboratory blood tests were normal, blood cultures were negative, and brain imaging revealed an abscess. Cardiology consultation was requested, and transthoracic echocardiography revealed an intracardiac vegetation. Empiric antibiotic treatment with sultamicillin, gentamycin, and meropenem was initiated. Serology testing was positive for Coxiella burnetii, and the diagnosis of BCNIE was established. The antibiotic course was changed to oral doxycycline for 36 months and led to resolution of IE, with no vegetation detected on TTE after 15 months. Conclusion BCNIE is a life-threatening disease entity that can lead to severe complications, such as valve regurgitation, emboli, and death. Patients with congenital heart disease are particularly vulnerable to IE. Timely diagnosis and antibiotic management are of paramount importance in order to avoid the potentially fatal sequelae.
Collapse
|
9
|
Coxiella burnetii-infected abdominal endovascular aortic stent graft in a kidney transplant recipient. Enferm Infecc Microbiol Clin 2020; 39:207-208. [PMID: 32660733 DOI: 10.1016/j.eimc.2020.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 06/03/2020] [Accepted: 06/08/2020] [Indexed: 11/23/2022]
|
10
|
Hamon A, El Sayed F, Bouchand F, Davido B, Duran C, Coggia M, Javerliat I, Dinh A. [Coxiella burnetii infection of endovascular aortic graft]. Med Mal Infect 2020; 50:620-623. [PMID: 32113867 DOI: 10.1016/j.medmal.2020.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 06/27/2019] [Accepted: 02/07/2020] [Indexed: 10/25/2022]
Affiliation(s)
- A Hamon
- Service de maladies infectieuses, hôpital Raymond-Poincaré, 104, boulevard Raymond-Poincaré 92380 Garches, France
| | - F El Sayed
- Service de microbiologie, hôpital Ambroise-Paré, AP-HP, 92100 Boulogne Billancourt, France
| | - F Bouchand
- Service de pharmacie, hôpital Raymond-Poincaré, AP-HP, 92380 Garches, France
| | - B Davido
- Service de maladies infectieuses, hôpital Raymond-Poincaré, 104, boulevard Raymond-Poincaré 92380 Garches, France
| | - C Duran
- Service de maladies infectieuses, hôpital Raymond-Poincaré, 104, boulevard Raymond-Poincaré 92380 Garches, France
| | - M Coggia
- Service de chirurgie vasculaire, hôpital Ambroise-Paré, AP-HP, 92100 Boulogne Billancourt, France
| | - I Javerliat
- Service de chirurgie vasculaire, hôpital Ambroise-Paré, AP-HP, 92100 Boulogne Billancourt, France
| | - A Dinh
- Service de maladies infectieuses, hôpital Raymond-Poincaré, 104, boulevard Raymond-Poincaré 92380 Garches, France.
| |
Collapse
|
11
|
Persistent Coxiella burnetii cardiovascular infection on Bentall-De Bono prosthesis. Eur J Clin Microbiol Infect Dis 2020; 39:1003-1010. [DOI: 10.1007/s10096-020-03816-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 01/12/2020] [Indexed: 12/13/2022]
|
12
|
Introduction to Measurement of Avidity of Anti-Coxiella burnetii IgG in Diagnosis of Q Fever. J Clin Microbiol 2019; 57:JCM.00539-19. [PMID: 31366688 DOI: 10.1128/jcm.00539-19] [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: 04/02/2019] [Accepted: 07/23/2019] [Indexed: 01/17/2023] Open
Abstract
Due to the atypical serological profile of some patients with primary Q fever infection who do not develop IgM against Coxiella burnetii, we developed an avidity test to distinguish recent or past infections. We tested 39 serum samples by immunofluorescence with conventional assay and after urea treatment from 26 patients at different stages of the disease. We observed a strong avidity in the 15 serum samples from patients with infections of >6 months and a low avidity for sera from patients with recent infections. A complete denaturation of the antibody-antigen complex was observed for patients for whom the time since the beginning of infection was <1 month and a mean of 2.06 ± 0.54 lowered titers when the infection was less than 3 months old. That was statistically significant compared to sera from patients with infections of greater than 6 months (mean 0.20 ± 0.41) and with infections between 3 and 6 months (mean, 1.17 ± 0.41) (P = 0.0022 and P < 0.0001, respectively). These results were visualized by Western blotting. We concluded that high avidity (≤1 lowered titer) ruled out infection during the last 6 months and that complete denaturation was related to an infection which had occurred within the previous 3 months. Between these two situations, the avidity test is inconclusive. We suggest using an avidity test for atypical Q fever serology that could be misclassified as residual antibodies (IgG against C. burnetii detected without active or recent infection) and for pregnant women risking obstetrical complications. This new test will dramatically improve the diagnosis and management of patients with Q fever.
Collapse
|
13
|
Chronic Q Fever with Vascular Involvement: Progressive Abdominal Pain in a Patient with Aortic Aneurysm Repair in the United States. Case Rep Infect Dis 2019; 2019:5369707. [PMID: 30915246 PMCID: PMC6399537 DOI: 10.1155/2019/5369707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 01/30/2019] [Indexed: 11/18/2022] Open
Abstract
Q fever is a zoonotic bacterial infection caused by Coxiella burnetii. Chronic Q fever comprises less than five percent of all Q fever cases and, of those, endocarditis is the most common presentation (up to 78% of cases), followed by vascular involvement. Risk factors for chronic Q fever with vascular involvement include previous vascular surgery, preexisting valvular defects, aneurysms, and vascular prostheses. The most common symptoms of chronic Q fever with vascular involvement are nonspecific, including weight loss, fatigue, and abdominal pain. Criteria for diagnosis of chronic Q fever include clinical evidence of infection and laboratory criteria (antibody detection, detection of Coxiella burnetii DNA, or growth in culture). Treatment of chronic Q fever with vascular involvement includes a prolonged course of doxycycline and hydroxychloroquine (≥18 months) as well as early surgical intervention, which has been shown to improve survival. Mortality is high in untreated chronic Q fever. We report a case of chronic Q fever with vascular involvement in a 77-year-old man with prior infrarenal aortic aneurysm repair, who lived near a livestock farm in the southeastern United States.
Collapse
|
14
|
Karhof S, van Roeden SE, Oosterheert JJ, Bleeker-Rovers CP, Renders NHM, de Borst GJ, Kampschreur LM, Hoepelman AIM, Koning OHJ, Wever PC. Primary and secondary arterial fistulas during chronic Q fever. J Vasc Surg 2019; 68:1906-1913.e1. [PMID: 29685511 DOI: 10.1016/j.jvs.2018.01.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 01/18/2018] [Indexed: 12/25/2022]
Abstract
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.
Collapse
Affiliation(s)
- Steffi Karhof
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sonja E van Roeden
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Jan J Oosterheert
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Chantal P Bleeker-Rovers
- Division of Infectious Diseases, Department of Internal Medicine, Radboud University Medical Center and Radboud Expertise Center for Q Fever, Nijmegen, The Netherlands
| | - Nicole H M Renders
- Department of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Gert J de Borst
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Linda M Kampschreur
- Department of Internal Medicine and Infectious Diseases, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Andy I M Hoepelman
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Olivier H J Koning
- Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Peter C Wever
- Department of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| |
Collapse
|
15
|
van Roeden SE, Wever PC, Kampschreur LM, Gruteke P, van der Hoek W, Hoepelman AIM, Bleeker-Rovers CP, Oosterheert JJ. Chronic Q fever-related complications and mortality: data from a nationwide cohort. Clin Microbiol Infect 2018; 25:1390-1398. [PMID: 30543852 DOI: 10.1016/j.cmi.2018.11.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 10/12/2018] [Accepted: 11/26/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Chronic infection with Coxiella burnetii (chronic Q fever) can cause life-threatening conditions such as endocarditis, infected vascular prostheses, and infected arterial aneurysms. We aimed to assess prognosis of chronic Q fever patients in terms of complications and mortality. METHODS A large cohort of chronic Q fever patients was assessed to describe complications, overall mortality and chronic Q fever-related mortality. Chronic Q fever-related mortality was expressed as a case fatality rate (number of chronic Q fever-related deaths/number of chronic Q fever patients). RESULTS Complications occurred in 166 of 439 (38%) chronic Q fever patients: in 61% of proven (153/249), 15% of probable (11/74), and 2% of possible chronic Q fever patients (2/116). Most frequently observed complications were acute aneurysms (14%), heart failure (13%), and non-cardiac abscesses (10%). Overall mortality was 38% (94/249) for proven chronic Q fever patients (median follow-up 3.6 years) and 22% (16/74) for probable chronic Q fever patients (median follow-up 4.7 years). The case fatality rate was 25% for proven (63/249) chronic Q fever patients and 4% for probable (3/74) chronic Q fever patients. Overall survival was significantly lower in patients with complications, compared to those without complications (p <0.001). CONCLUSIONS In chronic Q fever patients, complications occur frequently and contribute to the mortality rate. Patients with proven chronic Q fever have the highest risk of complications and chronic Q fever-related mortality. Prognosis for patients with possible chronic Q fever is favourable in terms of complications and mortality.
Collapse
Affiliation(s)
- S E van Roeden
- University Medical Centre Utrecht, Utrecht, the Netherlands.
| | - P C Wever
- Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | | | - P Gruteke
- Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - W van der Hoek
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | | | | | | |
Collapse
|
16
|
Ernest V, Cammilleri S, Amabile P, Fedi M, Burtey S, Von Kotze C, Pelletier M, Moal V, Guedj E, Perron C, Boustani R, Berland Y, Brunet P, Raoult D, Fournier PE, Jourde-Chiche N. Hemodialysis vascular graft as a focus of persistent Q fever. Infection 2018; 46:881-884. [DOI: 10.1007/s15010-018-1206-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 08/23/2018] [Indexed: 12/14/2022]
|
17
|
Prudent E, Lepidi H, Angelakis E, Raoult D. Fluorescence In Situ Hybridization (FISH) and Peptide Nucleic Acid Probe-Based FISH for Diagnosis of Q Fever Endocarditis and Vascular Infections. J Clin Microbiol 2018; 56:e00542-18. [PMID: 29899006 PMCID: PMC6113452 DOI: 10.1128/jcm.00542-18] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 06/11/2018] [Indexed: 01/07/2023] Open
Abstract
Endocarditis and vascular infections are common manifestations of persistent localized infection due to Coxiella burnetii, and recently, fluorescence in situ hybridization (FISH) was proposed as an alternative tool for their diagnosis. In this study, we evaluated the efficiency of FISH in a series of valve and vascular samples infected by C. burnetii We tested 23 C. burnetii-positive valves and thrombus samples obtained from patients with Q fever endocarditis. Seven aneurysms and thrombus specimens were retrieved from patients with Q fever vascular infections. Samples were analyzed by culture, immunochemistry, and FISH with oligonucleotide and PNA probes targeting C. burnetii-specific 16S rRNA sequences. The immunohistochemical analysis was positive for five (17%) samples with significantly more copies of C. burnetii DNA than the negative ones (P = 0.02). FISH was positive for 13 (43%) samples and presented 43% and 40% sensitivity compared to that for quantitative PCR (qPCR) and culture, respectively. PNA FISH detected C. burnetii in 18 (60%) samples and presented 60% and 55% sensitivity compared to that for qPCR and culture, respectively. Immunohistochemistry had 38% and 28% sensitivity compared to that for FISH and PNA FISH, respectively. Samples found positive by both immunohistochemistry and PNA FISH contained significantly more copies of C. burnetii DNA than the negative ones (P = 0.03). Finally, PNA FISH was more sensitive than FISH (60% versus 43%, respectively) for the detection of C. burnetii We provide evidence that PNA FISH and FISH are important assays for the diagnosis of C. burnetii endocarditis and vascular infections.
Collapse
Affiliation(s)
- Elsa Prudent
- Aix Marseille Université, IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Hubert Lepidi
- Aix Marseille Université, IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Emmanouil Angelakis
- Aix Marseille Université, IRD, AP-HM, VITROME, IHU-Méditerranée Infection, Marseille, France
- French Reference Center for the Diagnosis and Study of Rickettsioses, Q fever and Bartonelloses, IHU-Méditerranée Infection, Marseille, France
| | - Didier Raoult
- Aix Marseille Université, IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| |
Collapse
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
de Worm S, Giot JB, Courtoy C, Gillet E, Amrane S, Huynen P, Van Esbroeck M, Prudent E, Lepidi H, Million M, Moutschen M, Raoult D. A case of giant cell arteritis associated with culture-proven Coxiella burnetii aortitis. Int J Infect Dis 2018; 69:50-54. [PMID: 29408476 DOI: 10.1016/j.ijid.2018.01.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 01/24/2018] [Accepted: 01/27/2018] [Indexed: 01/15/2023] Open
Abstract
A case of proven Coxiella burnetii aortitis, possibly associated with giant cell arteritis (GCA), is reported. A 72-year-old man, who is a hunter, presented with weight loss, fever, jaw claudication, and hardened temporal arteries associated with a persistent inflammatory syndrome and arteritis of the whole aorta, including the brachiocephalic arteries, as seen on 18F-fluorodeoxyglucose positron emission tomography/computed tomography. The diagnosis of GCA was retained, and treatment with prednisolone was started. Given the aneurysm of the abdominal aorta, the patient underwent replacement of the abdominal aorta with an allograft. Histology showed intense chronic arteritis attributed to atherosclerosis with dissection. However, Coxiella burnetii infection was confirmed by serology and then by culture and molecular biology on the surgical specimen. A combination of hydroxychloroquine and doxycycline was added to tapered prednisolone and the outcome was favourable.
Collapse
Affiliation(s)
- S de Worm
- Internal General Medicine and Infectious Diseases, CHU de Liège, 4000 Liège, Belgium
| | - J B Giot
- Internal General Medicine and Infectious Diseases, CHU de Liège, 4000 Liège, Belgium.
| | - C Courtoy
- Rheumatology, CHR de Verviers, 4800 Verviers, Belgium
| | - E Gillet
- General Practitioner, 4651 Battice, Belgium
| | - Sophie Amrane
- Aix Marseille Université, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - P Huynen
- Medical Microbiology, CHU de Liège, 4000 Liège, Belgium
| | - M Van Esbroeck
- Belgian National Reference Centre for Coxiella burnetii, Institute of Tropical Medicine, 2000 Anvers, Belgium
| | - E Prudent
- Aix Marseille Université, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - H Lepidi
- Aix Marseille Université, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Matthieu Million
- Aix Marseille Université, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - M Moutschen
- Internal General Medicine and Infectious Diseases, CHU de Liège, 4000 Liège, Belgium
| | - Didier Raoult
- Aix Marseille Université, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| |
Collapse
|
20
|
Greiner AL, Bhengsri S, Million M, Edouard S, Thamthitiwat S, Clarke K, Kersh GJ, Gregory CJ, Raoult D, Parola P. Acute Q Fever Case Detection among Acute Febrile Illness Patients, Thailand, 2002-2005. Am J Trop Med Hyg 2018; 98:252-257. [PMID: 29141767 PMCID: PMC5928714 DOI: 10.4269/ajtmh.17-0413] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 09/29/2017] [Indexed: 12/21/2022] Open
Abstract
Acute Q fever cases were identified from a hospital-based acute febrile illness study conducted in six community hospitals in rural north and northeast Thailand from 2002 to 2005. Of 1,784 participants that underwent Coxiella burnetii testing, nine (0.5%) participants were identified in this case-series as acute Q fever cases. Eight case-patients were located in one province. Four case-patients were hospitalized. Median age was 13 years (range: 7-69); five were male. The proportion of children with acute Q fever infection was similar to adults (P = 0.17). This previously unrecognized at-risk group, school-age children, indicates that future studies and prevention interventions should target this population. The heterogeneity of disease burden across Thailand and milder clinical presentations found in this case-series should be considered in future studies. As diagnosis based on serology is limited during the acute phase of the disease, other diagnostic options, such as polymerase chain reaction, should be explored to improve acute case detection.
Collapse
Affiliation(s)
- Ashley L. Greiner
- Division of Global Health Protection, Center for Global Health, United States Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Saithip Bhengsri
- Division of Global Health Protection, Center for Global Health, United States Centers for Disease Control and Prevention, Nonthaburi, Thailand
| | - Matthieu Million
- Aix Marseille Université, AP-HM, URMITE, IHU-Méditerranée Infection, Marseille, France
| | - Sophie Edouard
- Aix Marseille Université, AP-HM, URMITE, IHU-Méditerranée Infection, Marseille, France
| | - Somsak Thamthitiwat
- Division of Global Health Protection, Center for Global Health, United States Centers for Disease Control and Prevention, Nonthaburi, Thailand
| | - Kevin Clarke
- Division of Global Health Protection, Center for Global Health, United States Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gilbert J. Kersh
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, United States Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christopher J. Gregory
- Division of Global Health Protection, Center for Global Health, United States Centers for Disease Control and Prevention, Nonthaburi, Thailand
| | - Didier Raoult
- Aix Marseille Université, AP-HM, URMITE, IHU-Méditerranée Infection, Marseille, France
| | - Philippe Parola
- Aix Marseille Université, AP-HM, URMITE, IHU-Méditerranée Infection, Marseille, France
| |
Collapse
|
21
|
Eldin C, Mélenotte C, Mediannikov O, Ghigo E, Million M, Edouard S, Mege JL, Maurin M, Raoult D. From Q Fever to Coxiella burnetii Infection: a Paradigm Change. Clin Microbiol Rev 2017; 30:115-190. [PMID: 27856520 PMCID: PMC5217791 DOI: 10.1128/cmr.00045-16] [Citation(s) in RCA: 530] [Impact Index Per Article: 75.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Coxiella burnetii is the agent of Q fever, or "query fever," a zoonosis first described in Australia in 1937. Since this first description, knowledge about this pathogen and its associated infections has increased dramatically. We review here all the progress made over the last 20 years on this topic. C. burnetii is classically a strict intracellular, Gram-negative bacterium. However, a major step in the characterization of this pathogen was achieved by the establishment of its axenic culture. C. burnetii infects a wide range of animals, from arthropods to humans. The genetic determinants of virulence are now better known, thanks to the achievement of determining the genome sequences of several strains of this species and comparative genomic analyses. Q fever can be found worldwide, but the epidemiological features of this disease vary according to the geographic area considered, including situations where it is endemic or hyperendemic, and the occurrence of large epidemic outbreaks. In recent years, a major breakthrough in the understanding of the natural history of human infection with C. burnetii was the breaking of the old dichotomy between "acute" and "chronic" Q fever. The clinical presentation of C. burnetii infection depends on both the virulence of the infecting C. burnetii strain and specific risks factors in the infected patient. Moreover, no persistent infection can exist without a focus of infection. This paradigm change should allow better diagnosis and management of primary infection and long-term complications in patients with C. burnetii infection.
Collapse
Affiliation(s)
- Carole Eldin
- URMITE, UMR CNRS 7278, IRD 198, INSERM U1095, Faculté de Médecine, Marseille, France
| | - Cléa Mélenotte
- URMITE, UMR CNRS 7278, IRD 198, INSERM U1095, Faculté de Médecine, Marseille, France
| | - Oleg Mediannikov
- URMITE, UMR CNRS 7278, IRD 198, INSERM U1095, Faculté de Médecine, Marseille, France
| | - Eric Ghigo
- URMITE, UMR CNRS 7278, IRD 198, INSERM U1095, Faculté de Médecine, Marseille, France
| | - Matthieu Million
- URMITE, UMR CNRS 7278, IRD 198, INSERM U1095, Faculté de Médecine, Marseille, France
| | - Sophie Edouard
- URMITE, UMR CNRS 7278, IRD 198, INSERM U1095, Faculté de Médecine, Marseille, France
| | - Jean-Louis Mege
- URMITE, UMR CNRS 7278, IRD 198, INSERM U1095, Faculté de Médecine, Marseille, France
| | - Max Maurin
- Institut de Biologie et de Pathologie, CHU de Grenoble, Grenoble, France
| | - Didier Raoult
- URMITE, UMR CNRS 7278, IRD 198, INSERM U1095, Faculté de Médecine, Marseille, France
| |
Collapse
|
22
|
Eldin C, Melenotte C, Million M, Cammilleri S, Sotto A, Elsendoorn A, Thuny F, Lepidi H, Roblot F, Weitten T, Assaad S, Bouaziz A, Chapuzet C, Gras G, Labussiere AS, Landais C, Longuet P, Masseau A, Mundler O, Raoult D. 18F-FDG PET/CT as a central tool in the shift from chronic Q fever to Coxiella burnetii persistent focalized infection: A consecutive case series. Medicine (Baltimore) 2016; 95:e4287. [PMID: 27559944 PMCID: PMC5400310 DOI: 10.1097/md.0000000000004287] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Because Q fever is mostly diagnosed serologically, localizing a persistent focus of Coxiella burnetii infection can be challenging. F-fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG PET/CT) could be an interesting tool in this context.We performed a retrospective study on patients diagnosed with C burnetii infection, who had undergone F-FDG PET/CT between 2009 and 2015. When positive F-FDG PET/CT results were obtained, we tried to determine if it changed the previous diagnosis by discovering or confirming a suspected focus of C burnetii infection.One hundred sixty-seven patients benefited from F-FDG PET/CT. The most frequent clinical subgroup before F-FDG PET/CT was patients with no identified focus of infection, despite high IgG1 serological titers (34%). For 59% (n = 99) of patients, a hypermetabolic focus was identified. For 62 patients (62.6%), the positive F-FDG PET/CT allowed the diagnosis to be changed. For 24 of them, (38.7%), a previously unsuspected focus of infection was discovered. Forty-two (42%) positive patients had more than 1 hypermetabolic focus. We observed 21 valvular foci, 34 vascular foci, and a high proportion of osteoarticular localizations (n = 21). We also observed lymphadenitis (n = 27), bone marrow hypermetabolism (n = 11), and 9 pulmonary localizations.We confirmed thatF-FDG PET/CT is a central tool in the diagnosis of C burnetii focalized persistent infection. We proposed new diagnostic scores for 2 main clinical entities identified using F-FDG PET/CT: osteoarticular persistent infections and lymphadenitis.
Collapse
Affiliation(s)
- Carole Eldin
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Faculté de Médecine, CNRS UMR 7278, IRD 198, Aix-Marseille Université, 27 Bd Jean Moulin
| | - Cléa Melenotte
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Faculté de Médecine, CNRS UMR 7278, IRD 198, Aix-Marseille Université, 27 Bd Jean Moulin
| | - Matthieu Million
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Faculté de Médecine, CNRS UMR 7278, IRD 198, Aix-Marseille Université, 27 Bd Jean Moulin
| | | | - Albert Sotto
- Service de pathologies infectieuses et tropicales de l’hôpital de Nimes
| | | | - Franck Thuny
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Faculté de Médecine, CNRS UMR 7278, IRD 198, Aix-Marseille Université, 27 Bd Jean Moulin
- Unité Nord Insuffisance cardiaque et valvulopathies (UNIV), Service de cardiologie CHU de Marseille, Hôpital Nord, AP-HM Chemin des Bourrely, Marseille
| | - Hubert Lepidi
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Faculté de Médecine, CNRS UMR 7278, IRD 198, Aix-Marseille Université, 27 Bd Jean Moulin
| | - France Roblot
- Service de Pathologies infectieuses et tropicales, CHU de Poitiers
| | | | - Souad Assaad
- Service de Médecine interne, hôpital Saint Luc, Lyon
| | | | - Claire Chapuzet
- Service de Pathologies infectieuses et tropicales, CHU de Rouen
| | - Guillaume Gras
- Service de Pathologies infectieuses et tropicales, CHU de Tours
| | | | | | - Pascale Longuet
- Service mobile d’Infectiologie, CH Victor Dupouy, Argenteuil
| | | | - Olivier Mundler
- Service de médecine nucléaire, Hôpital de La Timone, Marseille
| | - Didier Raoult
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Faculté de Médecine, CNRS UMR 7278, IRD 198, Aix-Marseille Université, 27 Bd Jean Moulin
- Correspondence: Didier Raoult, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Faculté de médecine, 27 boulevard Jean Moulin, 13005 Marseille, France (e-mail: )
| |
Collapse
|