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Fragner M, Srivats SS, Pink K, Abuhashish H. Atypical Presentation of Coxiella burnetii Endocarditis: Diagnostic Considerations and the Importance of Keeping a Broad Differential. Cureus 2024; 16:e63659. [PMID: 39092334 PMCID: PMC11292982 DOI: 10.7759/cureus.63659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2024] [Indexed: 08/04/2024] Open
Abstract
Coxiella burnetii is a gram-negative bacterium associated with serious complications such as infective endocarditis. Early diagnosis and treatment can be difficult due to its nonspecific presentation and risk factors that include contact with farm animals or their byproducts. Here, we present an atypical presentation of infective endocarditis caused by Coxiella burnetii, where the patient had no risk factors, negative Duke criteria, and negative preliminary workup.
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Affiliation(s)
- Michael Fragner
- Internal Medicine, New York-Presbyterian Brooklyn Methodist, Brooklyn, USA
| | | | - Kevin Pink
- Cardiology, New York-Presbyterian Brooklyn Methodist, Brooklyn, USA
| | - Hassan Abuhashish
- Internal Medicine, New York-Presbyterian Brooklyn Methodist, Brooklyn, USA
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2
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El Zein S, Challener DW, Ranganath N, Khodadadi RB, Theel ES, Abu Saleh OM. Acute Coxiella burnetii Infection: A 10-Year Clinical Experience at a Tertiary Care Center in the United States. Open Forum Infect Dis 2024; 11:ofae277. [PMID: 38868311 PMCID: PMC11167673 DOI: 10.1093/ofid/ofae277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/08/2024] [Indexed: 06/14/2024] Open
Abstract
Background Identifying and treating patients with acute Q fever who are at an increased risk of progressing to persistent disease is crucial for preventing future complications. In this study, we share our decade-long clinical experience with acute Q fever, highlighting the challenges that clinicians encounter from making an initial diagnosis and performing risk stratification to determining the appropriate prophylaxis regimen and duration. Methods We retrieved records of adult Mayo Clinic patients (≥18 years) with positive Coxiella burnetii serology results between 1 January 2012 and 31 March 2022. Patients with Q fever anti-phase II immunoglobulin G ≥1:256 by indirect immunofluorescence were further analyzed. Results Thirty-one patients were included. Their median age was 58 years (IQR, 50-64), and the majority were men (84%). Acute hepatitis (29%), flu-like illness (25.8%), and pneumonia (16%) were the most common presentations. Thirteen patients (42%) received antibiotic prophylaxis to prevent disease progression, with significant variation in the indications and duration across physicians. The combination of doxycycline and hydroxychloroquine was the preferred regimen. Prophylaxis was administered for a median 333 days (IQR, 168-414). Four patients (13%) progressed to Q fever native valve infective endocarditis, with elevated anticardiolipin immunoglobulin G levels being the sole risk factor in 2 cases. The small sample size precluded drawing conclusions on the impact of prophylaxis in preventing disease progression. Conclusions Management of acute Q fever is complicated by the lack of comprehensive clinical guidelines leading to varied clinical practices. There is a critical need for randomized trials to establish robust evidence-based protocols for management.
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Affiliation(s)
- Said El Zein
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Doug W Challener
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Nischal Ranganath
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan B Khodadadi
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Elitza S Theel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Omar M Abu Saleh
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
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3
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Ramos JC, Santos D, Dias P. Large-Vessel Vasculitis and Q Fever Correlation. Eur J Case Rep Intern Med 2023; 11:004110. [PMID: 38223281 PMCID: PMC10783453 DOI: 10.12890/2023_004110] [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: 10/02/2023] [Accepted: 11/22/2023] [Indexed: 01/16/2024] Open
Abstract
Q fever is a zoonotic infection caused by the pathogen Coxiella burnetii, and patients can present with a wide spectrum of clinical manifestations, depending on whether it is an acute or a chronic infection. We present the case of a 61-year-old male with fatigue, posterior thoracalgia, intermittent fever, night sweats and weight loss for a month. After an extensive workup, he was diagnosed with acute Q fever with large-vessel vasculitis. The FDG-PET/CT scan suggested an active vasculitis specifically in the thoracic aorta, proximal abdominal aorta, subclavian and carotid vessels, suggesting an immunologic response to acute Q fever infection, barely reported worldwide. LEARNING POINTS Large-vessel vasculitis is a possible immunologic response to acute Q fever infection.There are few data about the management and treatment of patients with Q fever related large-vessel vasculitis.
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Affiliation(s)
- Joana C Ramos
- Internal Medicine Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
| | - Daniela Santos
- Internal Medicine Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
| | - Patrícia Dias
- Internal Medicine Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
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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.
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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;
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Hysenaj L, de Laval B, Arce-Gorvel V, Bosilkovski M, González-Espinoza G, Debroas G, Sieweke MH, Sarrazin S, Gorvel JP. CD150-dependent hematopoietic stem cell sensing of Brucella instructs myeloid commitment. J Exp Med 2023; 220:e20210567. [PMID: 37067792 PMCID: PMC10114919 DOI: 10.1084/jem.20210567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 01/05/2023] [Accepted: 03/13/2023] [Indexed: 04/18/2023] Open
Abstract
So far, hematopoietic stem cells (HSC) are considered the source of mature immune cells, the latter being the only ones capable of mounting an immune response. Recent evidence shows HSC can also directly sense cytokines released upon infection/inflammation and pathogen-associated molecular pattern interaction while keeping a long-term memory of previously encountered signals. Direct sensing of danger signals by HSC induces early myeloid commitment, increases myeloid effector cell numbers, and contributes to an efficient immune response. Here, by using specific genetic tools on both the host and pathogen sides, we show that HSC can directly sense B. abortus pathogenic bacteria within the bone marrow via the interaction of the cell surface protein CD150 with the bacterial outer membrane protein Omp25, inducing efficient functional commitment of HSC to the myeloid lineage. This is the first demonstration of direct recognition of a live pathogen by HSC via CD150, which attests to a very early contribution of HSC to immune response.
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Affiliation(s)
- Lisiena Hysenaj
- Aix Marseille University, Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, Centre d’Immunologie de Marseille-Luminy, Marseille, France
- Department of Anatomy, University of California, San Francisco, San Francisco, CA, USA
| | - Bérengère de Laval
- Aix Marseille University, Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, Centre d’Immunologie de Marseille-Luminy, Marseille, France
| | - Vilma Arce-Gorvel
- Aix Marseille University, Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, Centre d’Immunologie de Marseille-Luminy, Marseille, France
| | - Mile Bosilkovski
- University Clinic for Infectious Diseases and Febrile Conditions, Skopje, Republic of North Macedonia
| | - Gabriela González-Espinoza
- Aix Marseille University, Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, Centre d’Immunologie de Marseille-Luminy, Marseille, France
| | - Guilhaume Debroas
- Aix Marseille University, Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, Centre d’Immunologie de Marseille-Luminy, Marseille, France
| | - Michael H. Sieweke
- Aix Marseille University, Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, Centre d’Immunologie de Marseille-Luminy, Marseille, France
- Center for Regenerative Therapies Dresden, Technische Universität Dresden, Dresden, Germany
| | - Sandrine Sarrazin
- Aix Marseille University, Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, Centre d’Immunologie de Marseille-Luminy, Marseille, France
| | - Jean-Pierre Gorvel
- Aix Marseille University, Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, Centre d’Immunologie de Marseille-Luminy, Marseille, France
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Kanowski VA, Bhutia SG. Vascular Complications in Coxiella burnetii Infection: A Report of Two Cases. EJVES Vasc Forum 2023; 59:31-35. [PMID: 37389372 PMCID: PMC10300310 DOI: 10.1016/j.ejvsvf.2023.05.005] [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: 07/20/2022] [Revised: 02/06/2023] [Accepted: 05/09/2023] [Indexed: 07/01/2023] Open
Abstract
Introduction First described in 1937, Q fever remains a relatively new disease, with much to be learned about its presentation and diagnosis. Due to its role in the development of aortic aneurysms and vascular graft infections, its implications in the vascular domain have become increasingly reported. This is a report of two cases of vascular complications associated with Coxiella burnetii infection, and the challenges in managing their unique presentations. Reports Case 1: A 70 year old man with a prosthetic aortobiiliac graft and past Q fever infection presented with acute sepsis. Abdominal computed tomography (CT) showed soft tissue thickening and stranding around the graft, and locules of gas within the vessel. Pelvic magnetic resonance imaging (MRI) revealed a chain of abscesses within the right gluteal region, of which aspirate grew Prevotella oris and Escherichia coli. Open explanation of the aortic graft and replacement by superficial femoral vein was performed. Tissue culture confirmed a polymicrobial infection, and PCR of the aortic wall and pre-aortic lymph node was positive for Q fever. He was treated for recrudescent Q fever infection with a good outcome and recovery. Case 2: A 73 year old man had an incidental abdominal aortic aneurysm (AAA) identified at the time of Q fever diagnosis. Following an incomplete course of doxycycline and hydroxychloroquine, the aneurysm rapidly progressed, leading to presentation with right flank pain. Fluorodeoxyglucose (FDG) positron emission tomography (PET) showed multiple foci of uptake within the aneurysm wall. Open AAA repair with a polyester graft was performed, with AAA tissue positive for Q fever on PCR. The operation was successful, with the patient continuing clearance therapy at time of writing. Discussion Q fever infection poses serious implications for patients with vascular grafts and AAAs, and thus, should be considered in the differential diagnosis of mycotic aortic aneurysms and in aortic graft infections.
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Affiliation(s)
| | - Sherab G. Bhutia
- Department of Vascular Surgery, Cairns Hospital, Cairns, Queensland, Australia
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Kraft DC, Naeem M, Mansour J, Beal MA, Bailey TC, Bhalla S. Body Imaging of Bacterial and Parasitic Zoonoses: Keys to Diagnosis. Radiographics 2023; 43:e220092. [PMID: 36729948 DOI: 10.1148/rg.220092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Zoonotic infections, which are transmitted from animals to humans, have been a substantial source of human disease since antiquity. As the human population continues to grow and human influence on the planet expands, humans frequently encounter both domestic and wild animals. This has only increased as deforestation, urbanization, agriculture, habitat fragmentation, outdoor recreation, and international travel evolve in modern society, all of which have resulted in the emergence and reemergence of zoonotic infections. Zoonotic infections pose a diagnostic challenge because of their nonspecific clinical manifestations and the need for specialized testing procedures to confirm these diagnoses. Affected patients often undergo imaging during their evaluation, and a radiologist familiar with the specific and often subtle imaging patterns of these infections can add important clinical value. The authors review the multimodality thoracic, abdominal, and musculoskeletal imaging findings of zoonotic bacterial (eg, Bartonella henselae, Pasteurella multocida, Francisella tularensis, Coxiella burnetii, and Brucella species), spirochetal (eg, Leptospira species), and parasitic (eg, Echinococcus, Paragonimus, Toxocara, and Dirofilaria species) infections that are among the more commonly encountered zoonoses in the United States. Relevant clinical, epidemiologic, and pathophysiologic clues such as exposure history, occupational risk factors, and organism life cycles are also reviewed. Although many of the imaging findings of zoonotic infections overlap with those of nonzoonotic infections, granulomatous diseases, and malignancies, radiologists' familiarity with the imaging patterns can aid in the differential diagnosis in a patient with a suspected or unsuspected zoonotic infection. © RSNA, 2023 Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- David C Kraft
- From the Department of Radiology, Baylor University Medical Center, 3500 Gaston Ave, Dallas, Texas 75246-2017 (D.C.K.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (M.N.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (J.M.); and Mallinckrodt Institute of Radiology (M.A.B., S.B.) and Department of Infectious Diseases (T.C.B.), Washington University School of Medicine, St Louis, Mo
| | - Muhammad Naeem
- From the Department of Radiology, Baylor University Medical Center, 3500 Gaston Ave, Dallas, Texas 75246-2017 (D.C.K.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (M.N.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (J.M.); and Mallinckrodt Institute of Radiology (M.A.B., S.B.) and Department of Infectious Diseases (T.C.B.), Washington University School of Medicine, St Louis, Mo
| | - Joseph Mansour
- From the Department of Radiology, Baylor University Medical Center, 3500 Gaston Ave, Dallas, Texas 75246-2017 (D.C.K.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (M.N.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (J.M.); and Mallinckrodt Institute of Radiology (M.A.B., S.B.) and Department of Infectious Diseases (T.C.B.), Washington University School of Medicine, St Louis, Mo
| | - Michael A Beal
- From the Department of Radiology, Baylor University Medical Center, 3500 Gaston Ave, Dallas, Texas 75246-2017 (D.C.K.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (M.N.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (J.M.); and Mallinckrodt Institute of Radiology (M.A.B., S.B.) and Department of Infectious Diseases (T.C.B.), Washington University School of Medicine, St Louis, Mo
| | - Thomas C Bailey
- From the Department of Radiology, Baylor University Medical Center, 3500 Gaston Ave, Dallas, Texas 75246-2017 (D.C.K.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (M.N.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (J.M.); and Mallinckrodt Institute of Radiology (M.A.B., S.B.) and Department of Infectious Diseases (T.C.B.), Washington University School of Medicine, St Louis, Mo
| | - Sanjeev Bhalla
- From the Department of Radiology, Baylor University Medical Center, 3500 Gaston Ave, Dallas, Texas 75246-2017 (D.C.K.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (M.N.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (J.M.); and Mallinckrodt Institute of Radiology (M.A.B., S.B.) and Department of Infectious Diseases (T.C.B.), Washington University School of Medicine, St Louis, Mo
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Screening for Coxiella Burnetii in Dairy Cattle Herds in Poland. J Vet Res 2022; 66:549-557. [PMID: 36846027 PMCID: PMC9945005 DOI: 10.2478/jvetres-2022-0070] [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: 10/19/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction The intracellular bacterium Coxiella burnetii is the aetiological agent of Q fever, a zoonosis affecting many animal species worldwide. Cattle and small ruminants are considered the major reservoirs of the bacteria and they shed it through multiple routes. Material and Methods A total of 2,180 sera samples from 801 cattle herds in all Polish voivodeships were tested by ELISA for the presence of specific antibodies. Milk samples were obtained from seropositive cows in 133 herds as part of a separate study. The milk samples were examined by ELISA and real-time PCR tests. Results Seroprevalence at the animal level was 7.06% and true positive seroprevalence was 6.0% (95% confidence interval (CI) 1.1-9.4). Seroprevalence at the herd level was estimated at 11.1% and true positive seroprevalence was 10.5% (95% CI 3.2-15.8). Shedding of the pathogen in milk was detected by real-time PCR in 33 out of 133 tested herds (24.81%, 95% CI 17.74-33.04%) and the presence of C. burnetii antibodies was confirmed in 85 of them (63.9%, 95% CI 55.13-72.05%). The highest level of conformity between ELISA and real-time PCR results was obtained for bulk tank milk samples. Conclusion Coxiella burnetii infections are quite common in cattle herds across the country, which emphasises the crucial roles of surveillance and adequate biosecurity measures in the prevention and limitation of Q fever spread in Poland.
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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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Bae M, Lee HJ, Park JH, Bae S, Jung J, Kim MJ, Lee SO, Choi SH, Kim YS, Shin Y, Kim SH. Molecular diagnosis of Coxiella burnetii in culture negative endocarditis and vascular infection in South Korea. Ann Med 2021; 53:2256-2265. [PMID: 34809520 PMCID: PMC8805875 DOI: 10.1080/07853890.2021.2005821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Q fever endocarditis is a major cause of culture-negative endocarditis. The role of Coxellia burnetii is underestimated because it is difficult to diagnose. We investigated the significance of C. burnetii as the cause of culture-negative endocarditis and vascular infection by examining blood and tissue specimens using serological testing and polymerase chain reaction (PCR). METHODS All patients with infective endocarditis or large vessel vasculitis were prospectively enrolled at a tertiary-care hospital from May 2016 through September 2020. Q fever endocarditis and vascular infection were diagnosed based on: (1) positive PCR for a cardiac valve or vascular tissue, (2) positive PCR for blood or phase I immunoglobulin G (IgG) ≥ 6400, or (3) phase I IgG ≥ 800 and < 6400 with morphologic abnormality. PCR targeted C. burnetii transposase gene insertion element IS1111a. RESULTS Of the 163 patients, 40 (25%) had culture-negative endocarditis (n = 35) or vascular infection (n = 5). Of the 40 patients, 24 (60%) were enrolled. Eight (33%) were diagnosed with Q fever endocarditis or vascular infection. Of these 8 patients, 6 had suspected acute Q fever endocarditis or vascular infection with negative phase I IgG. Six patients were not treated for C. burnetii, 4 were stable after surgery. One patient died due to surgical site infection after 5 months post-operatively and one died due to worsening underlying disease. CONCLUSIONS Approximately one-third of patients with culture-negative endocarditis and vascular infection was diagnosed as Q fever. Q fever endocarditis and vascular infection may be underestimated in routine clinical practice in South Korea.KEY MESSAGEQ fever endocarditis and vascular infection may be underestimated in routine clinical practice, thus, try to find evidence of C. burnetti infection in suspected patients by all available diagnostic tests including PCR.
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Affiliation(s)
- Moonsuk Bae
- Department of Infectious Diseases, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.,Division of Infectious Diseases, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Hyo Joo Lee
- Department of Convergence Medicine, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.,Department of Biotechnology, Yonsei University, Seoul, Republic of Korea
| | - Joung Ha Park
- Department of Infectious Diseases, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seongman Bae
- Department of Infectious Diseases, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jiwon Jung
- Department of Infectious Diseases, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min Jae Kim
- Department of Infectious Diseases, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Oh Lee
- Department of Infectious Diseases, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Ho Choi
- Department of Infectious Diseases, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yang Soo Kim
- Department of Infectious Diseases, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yong Shin
- Department of Convergence Medicine, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.,Department of Biotechnology, Yonsei University, Seoul, Republic of Korea
| | - Sung-Han Kim
- Department of Infectious Diseases, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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11
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Ghanem-Zoubi N, Paul M, Szwarcwort M, Agmon Y, Kerner A. Screening for Q Fever in Patients Undergoing Transcatheter Aortic Valve Implantation, Israel, June 2018-May 2020. Emerg Infect Dis 2021; 27:2205-2207. [PMID: 34287127 PMCID: PMC8314821 DOI: 10.3201/eid2708.204963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Q fever infective endocarditis frequently mimics degenerative valvular disease. We tested for Coxiella burnettii antibodies in 155 patients in Israel who underwent transcatheter aortic valve implantation. Q fever infective endocarditis was diagnosed and treated in 4 (2.6%) patients; follow-up at a median 12 months after valve implantation indicated preserved prosthetic valvular function.
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12
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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.
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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
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13
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A case report of autochthonous Q fever with pneumonia and hepatitis in northeastern China. BIOSAFETY AND HEALTH 2021. [DOI: 10.1016/j.bsheal.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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14
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Dabaja-Younis H, Meir M, Ilivizki A, Militianu D, Eidelman M, Kassis I, Shachor-Meyouhas Y. Q Fever Osteoarticular Infection in Children. Emerg Infect Dis 2020; 26. [PMID: 32818415 PMCID: PMC7454116 DOI: 10.3201/eid2609.191360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Studies of this condition, which is underestimated in children, will aid in its diagnosis and treatment. Q fever osteoarticular infection in children is an underestimated disease. We report 3 cases of Q fever osteomyelitis in children and review all cases reported in the literature through March 2018. A high index of suspicion is encouraged in cases of an unusual manifestation, prolonged course, relapsing symptoms, nonresolving or slowly resolving osteomyelitis, culture-negative osteomyelitis, or bone histopathology demonstrating granulomatous changes. Urban residence or lack of direct exposure to animals does not rule out infection. Diagnosis usually requires use of newer diagnostic modalities. Optimal antimicrobial therapy has not been well established; some case-patients may improve spontaneously or during treatment with a β-lactam. The etiology of treatment failure and relapse is not well understood, and tools for follow-up are lacking. Clinicians should be aware of these infections in children to guide optimal treatment, including choice of antimicrobial drugs, duration of therapy, and methods of monitoring response to treatment..
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15
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Manchal N, Adegboye OA, Eisen DP. A systematic review on the health outcomes associated with non-endocarditis manifestations of chronic Q fever. Eur J Clin Microbiol Infect Dis 2020; 39:2225-2233. [PMID: 32661808 DOI: 10.1007/s10096-020-03931-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 05/18/2020] [Indexed: 12/29/2022]
Abstract
The aim of this study was to systematically review the non-endocarditis manifestations of chronic Q fever and understand the significance of non-specific symptoms like pain and fatigue in chronic endovascular, osteomyelitis and abscess due to chronic Q fever. We performed a systematic review using Pub Med (the National Library of Medicine (NLM)) and Scopus databases. All studies in English on chronic Q fever that listed clinical manifestations other than infective endocarditis (IE) and chronic fatigue syndrome (CFS). Meta-analysis was carried out to investigate the effects of patient's health outcomes (pain, fatigue, the need for surgery and mortality) on vascular infections, osteomyelitis and abscess. Among cases not presenting as IE or CFS, vascular infections and osteomyelitis were the most common chronic Q fever disease manifestations. There were distinct regional patterns of disease. Compared with infective endocarditis, these are significantly associated with increased risk of pain: osteomyelitis (relative risk (RR) = 4.13, 95% confidence interval (CI) 3.36-5.07), abscess (RR = 3.59, 95% CI 3.28-3.93) and vascular infection (RR = 2.46, 95% CI 1.99-3.03). The strongest significant association was observed between osteomyelitis and pain. There was no significant association between fatigue and these manifestations. Clinicians have to be aware of uncommon manifestations of chronic Q fever as they present with non-specific symptoms and are significantly associated with increased risk of morbidity and mortality. The findings emphasise the need to investigate patients with positive chronic Q fever serology presenting with acute or chronic pain for possible underlying complications.
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Affiliation(s)
- Naveen Manchal
- Townsville Hospital and Health Service, Angus Smith Drive, Douglas, QLD, 4814, Australia.
- The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD, Australia.
| | - Oyelola A Adegboye
- Australian Institute of Tropical Health and Medicine, James Cook University, Discovery Drive, Douglas, QLD, 4814, Australia
| | - Damon P Eisen
- Townsville Hospital and Health Service, Angus Smith Drive, Douglas, QLD, 4814, Australia
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16
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Edouard S, Luciani L, Lagier JC, Raoult D. Current knowledge for the microbiological diagnosis of Tropheryma whipplei infection. Expert Opin Orphan Drugs 2020. [DOI: 10.1080/21678707.2020.1791700] [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] [Indexed: 12/17/2022]
Affiliation(s)
- Sophie Edouard
- IHU-Méditerranée Infection, Marseille, France
- Aix Marseille Univ, IRD, APHM, MEPHI, Marseille, France
| | - Léa Luciani
- IHU-Méditerranée Infection, Marseille, France
| | - Jean-Christophe Lagier
- IHU-Méditerranée Infection, Marseille, France
- Aix Marseille Univ, IRD, APHM, MEPHI, Marseille, France
| | - Didier Raoult
- IHU-Méditerranée Infection, Marseille, France
- Aix Marseille Univ, IRD, APHM, MEPHI, Marseille, France
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17
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Browning S, Lai K, Pickles R, Graves SR. Q fever vertebral osteomyelitis in the absence of cardiovascular involvement: Two cases and a literature review. CLINICAL INFECTION IN PRACTICE 2020. [DOI: 10.1016/j.clinpr.2020.100019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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18
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Microbial Safety of Milk Production and Fermented Dairy Products in Africa. Microorganisms 2020; 8:microorganisms8050752. [PMID: 32429521 PMCID: PMC7285323 DOI: 10.3390/microorganisms8050752] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/05/2020] [Accepted: 05/05/2020] [Indexed: 02/07/2023] Open
Abstract
In Africa, milk production, processing and consumption are integral part of traditional food supply, with dairy products being a staple component of recommended healthy diets. This review provides an overview of the microbial safety characteristics of milk production and fermented dairy products in Africa. The object is to highlight the main microbial food safety hazards in the dairy chain and to propose appropriate preventive and control measures. Pathogens of public health concern including Mycobacterium bovis, Brucella abortus and Coxiella burnettii, which have largely been eradicated in many developed nations, still persist in the dairy chain in Africa. Factors such as the natural antimicrobial systems in milk and traditional processing technologies, including fermentation, heating and use of antimicrobial additives, that can potentially contribute to microbial safety of milk and dairy products in Africa will be discussed. Practical approaches to controlling safety hazards in the dairy chain in Africa have been proposed. Governmental regulatory bodies need to set the necessary national and regional safety standards, perform inspections and put measures in place to ensure that the standards are met, including strong enforcement programs within smallholder dairy chains. Dairy chain actors would require upgraded knowledge and training in preventive approaches such as good agricultural practices (GAP), hazard analysis and critical control points (HACCP) design and implementation and good hygienic practices (GHPs). Food safety education programs should be incorporated into school curricula, beginning at the basic school levels, to improve food safety cognition among students and promote life-long safe food handling behaviour.
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19
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Vial G, Issa N, Carcaud C, Constans J, Camou F. Infectious aortitis mimicking Takayasu disease. JOURNAL DE MEDECINE VASCULAIRE 2020; 45:93-95. [PMID: 32265023 DOI: 10.1016/j.jdmv.2020.01.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 12/21/2019] [Indexed: 06/11/2023]
Affiliation(s)
- G Vial
- Intensive care unit, Saint André Hospital, 1, rue Jean-Burguet, 33075 Bordeaux cedex, France.
| | - N Issa
- Intensive care unit, Saint André Hospital, 1, rue Jean-Burguet, 33075 Bordeaux cedex, France
| | - C Carcaud
- Vascular medicine department, Saint André Hospital, 1, rue Jean-Burguet, 33075 Bordeaux cedex, France
| | - J Constans
- Vascular medicine department, Saint André Hospital, 1, rue Jean-Burguet, 33075 Bordeaux cedex, France
| | - F Camou
- Intensive care unit, Saint André Hospital, 1, rue Jean-Burguet, 33075 Bordeaux cedex, France
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20
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Akamine CM, Perez ML, Lee JH, Ing MB. Q Fever in Southern California: a Case Series of 20 Patients from a VA Medical Center. Am J Trop Med Hyg 2020; 101:33-39. [PMID: 31115296 PMCID: PMC6609200 DOI: 10.4269/ajtmh.18-0283] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Query fever (Q fever), caused by Coxiella burnetii, was first described in southern California in 1947. It was found to be endemic and enzoonotic to the region and associated with exposure to livestock. We describe a series of 20 patients diagnosed with Q fever at a Veterans Affairs hospital in southern California, with the aim of contributing toward the understanding of Q fever in this region. Demographics, laboratory data, diagnostic imaging, risk factors, and treatment regimens were collected via a retrospective chart review of patients diagnosed with Q fever at our institution between 2000 and 2016. Cases were categorized as acute or chronic and confirmed or probable. The majority presented with an acute febrile illness (90%). There was a delay in ordering diagnostic serology from the time of symptom onset (acute cases, average 31.9 days; chronic cases, average 63 days), and 15% progressed from acute to chronic infection. Of the chronic cases, 22.2% had endocarditis, 22.2% had endovascular infection, and 11.1% had both endocarditis and endovascular infection. The geographic distribution revealed that 20% resided in rural areas. Of the cases of Q fever that died, death attributed to Q fever was associated with an average diagnostic delay of 65.5 days. Acute Q fever is underreported in this region largely because of its often nonspecific clinical presentation.
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Affiliation(s)
- Christine M Akamine
- Department of Internal Medicine, Loma Linda University Health, Loma Linda, California
| | - Mario L Perez
- Division of Infectious Diseases, Kaiser Permanente Fontana Medical Center, Fontana, California
| | - Jea Hyun Lee
- Division of Infectious Diseases, Kaiser Permanente Fontana Medical Center, Fontana, California
| | - Michael B Ing
- Infectious Diseases Section, Veterans Affairs Loma Linda Healthcare System, Loma Linda, California
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21
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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]
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22
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Melenotte C, Million M, Raoult D. New insights in Coxiella burnetii infection: diagnosis and therapeutic update. Expert Rev Anti Infect Ther 2019; 18:75-86. [PMID: 31782315 DOI: 10.1080/14787210.2020.1699055] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Introduction: Coxiella burnetii infection is still challenging physicians, mainly because no international coordination has been stated to standardize the therapeutic strategy and improve the clinical outcomes.Areas covered: Based on the recent knowledge on Q fever, we review here the clinical practices from Q fever diagnosis to therapy. We searched PubMed and Google Scholar to perform the qualitative synthesis.Expert opinion: Four major critical points are highlighted in this review. The first point is that Q fever diagnosis has been reviewed in the light of the new diagnosis tools, including molecular biology, transthoracic echocardiography, and 18F-FDG-PET/CT-scan imaging. Q fever diagnosis results from the presence of a microbiological criterion in addition to a lesional criterion. Second, the identification of the anticardiolipin antibodies as a novel biological predictive marker for acute Q fever complications (hemophagocytic syndrome, acute Q fever endocarditis, alithiasic cholecystitis, hepatitis, and meningitis). Third, the observation of a coincidence between Q fever and non-Hodgkin lymphoma that has made persistent C. burnetii infection a risk of non-Hodgkin lymphoma. Finally, we expose here the close follow-up we proposed from the French National Reference Center for patients with Q fever infection to detect relapse and complications.
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Affiliation(s)
- Cléa Melenotte
- Infectious diseases department, Aix-Marseille University, IRD, APHM, MEPHI, Marseille, France.,Infectious diseases department, IHU - Méditerranée Infection, Marseille, France
| | - Matthieu Million
- Infectious diseases department, Aix-Marseille University, IRD, APHM, MEPHI, Marseille, France.,Infectious diseases department, IHU - Méditerranée Infection, Marseille, France
| | - Didier Raoult
- Infectious diseases department, Aix-Marseille University, IRD, APHM, MEPHI, Marseille, France.,Infectious diseases department, IHU - Méditerranée Infection, Marseille, France
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23
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Zanatto DCDS, Duarte JMB, Labruna MB, Tasso JB, Calchi AC, Machado RZ, André MR. Evidence of exposure to Coxiella burnetii in neotropical free-living cervids in South America. Acta Trop 2019; 197:105037. [PMID: 31128095 DOI: 10.1016/j.actatropica.2019.05.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/21/2019] [Accepted: 05/21/2019] [Indexed: 01/04/2023]
Abstract
Coxiella burnetii (order Legionellales, family Coxiellaceae), the etiological agent of Q fever, is a pleomorphic, obligate Gram-negative intracellular bacillococcus that can infect humans and animals. Among the mammals hosting this agent, both domestic and wild ruminants are of particular economic and public health importance. Ticks and other hematophagous arthropods or aerosols are incriminated in the transmission between reservoirs and susceptible hosts. This study used serological and molecular methods to investigate the C. burnetii occurrence in blood samples from free-living deer (143 Blastocerus dichotomus, 27 Mazama gouazoubira, 4 M. bororo, 3 M. americana, and 11 Ozotocerus bezoarticus) sampled in Mato-Grosso do Sul, São Paulo, Goiás and Paraná states in Brazil. The DNA extracted from the blood samples of 188 cervids was submitted to nested (n) PCR for C. burnetii based on the IS1111 repetitive insertion element of the heat shock protein (htpAB) gene. Additionally, 169 serum samples were submitted to Indirect Immunofluorescence Assay (IFAT) to detect Ig antibodies to C. burnetii. The nPCR results indicated that all blood samples were negative, evidencing the absence of circulating C. burnetii DNA in cervids from the studied regions or, alternatively, the C. burnetii DNA concentration in the deer blood samples was below the threshold of the used PCR technique. On the other hand, 5.32% (9/169) of deer were seropositive for C. burnetii by IFAT, with titers ranging from 256 and 16,384. In conclusion, the present work showed the first evidence of exposure of free-living deer to C. burnetii in Brazil.
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Affiliation(s)
- Diego Carlos de Souza Zanatto
- Programa de Pós-graduação em Microbiologia Agropecuária, Universidade Estadual Paulista Júlio de Mesquita Filho, Jaboticabal, São Paulo, Brazil; Departamento de Patologia Veterinária, Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), Jaboticabal, São Paulo, Brazil
| | | | - Marcelo Bahia Labruna
- Departamento de Medicina Veterinária Preventiva e Saúde Animal, Universidade de São Paulo, São Paulo, Brazil
| | - Júlia Banhareli Tasso
- Departamento de Patologia Veterinária, Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), Jaboticabal, São Paulo, Brazil
| | - Ana Cláudia Calchi
- Departamento de Patologia Veterinária, Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), Jaboticabal, São Paulo, Brazil
| | - Rosangela Zacarias Machado
- Departamento de Patologia Veterinária, Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), Jaboticabal, São Paulo, Brazil
| | - Marcos Rogério André
- Departamento de Patologia Veterinária, Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), Jaboticabal, São Paulo, Brazil.
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24
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Chenouard R, Hoppé E, Lemarié C, Talha A, Ducellier F, Ferchaud F, Kempf M, Edouard S, Abgueguen P, Rabier V, Pailhoriès H. A rare case of Prosthetic Joint Infection associated with Coxiella burnetii. Int J Infect Dis 2019; 87:166-169. [PMID: 31374343 DOI: 10.1016/j.ijid.2019.07.028] [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: 05/29/2019] [Revised: 07/24/2019] [Accepted: 07/24/2019] [Indexed: 01/15/2023] Open
Abstract
We report here the case of a Prosthetic Joint Infection (PJI) associated with Coxiella burnetii in a 62-year-old man with a revised total hip arthroplasty. The diagnosis was performed first by 16S rDNA sequencing on hip fluid aspirate, and confirmed by specific qPCR. Q fever has been reported in few cases of Prosthetic Joint Infections, often associated with chronic evolution and iterative surgeries. This case report alerts about such an unexpected diagnosis in a patient with no known risk factors.
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Affiliation(s)
- Rachel Chenouard
- Laboratoire de Bactériologie, Institut de Biologie en Santé, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Emmanuel Hoppé
- Service de Rhumatologie, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Carole Lemarié
- Laboratoire de Bactériologie, Institut de Biologie en Santé, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Abdelhafid Talha
- Service de Chirurgie Osseuse, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Florian Ducellier
- Service de Chirurgie Osseuse, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - François Ferchaud
- Service de Chirurgie Osseuse, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Marie Kempf
- Laboratoire de Bactériologie, Institut de Biologie en Santé, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Sophie Edouard
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France
| | - Pierre Abgueguen
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Valérie Rabier
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Hélène Pailhoriès
- Laboratoire de Bactériologie, Institut de Biologie en Santé, Centre Hospitalier Universitaire d'Angers, Angers, France.
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25
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Zanatto DCS, Gatto IRH, Labruna MB, Jusi MMG, Samara SI, Machado RZ, André MR. Coxiella burnetii associated with BVDV (Bovine Viral Diarrhea Virus), BoHV (Bovine Herpesvirus), Leptospira spp., Neospora caninum, Toxoplasma gondii and Trypanosoma vivax in reproductive disorders in cattle. ACTA ACUST UNITED AC 2019; 28:245-257. [PMID: 31215610 DOI: 10.1590/s1984-29612019032] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 04/22/2019] [Indexed: 02/01/2023]
Abstract
This is a cross-sectional study to assess the presence of antibodies in ruminants against selected pathogens associated with reproductive disorders in cattle in four Brazilian states, including the zoonotic agent Coxiella burnetii. The used tests were Virus Neutralization Assay for IBR and BVD, Microscopic Agglutination Test for Leptospira spp., Indirect Fluorescent Antibody Test (IFAT) for C. burnetii and Toxoplasma gondii, and Enzyme-Linked Immunosorbent Assay for Neospora caninum and Trypanosoma vivax. Seropositivity for C. burnetii was 13.7% with titers from 128 to 131,072; 57.8% for BoHV-1, with titers between 2 and 1,024; 47.1% for BVDV-1a, with titers from 10 to 5,120; 89.2% for N. caninum; 50% for T. vivax; and 52.0% for Leptospira spp., with titers between 100 to 800 (the following serovars were found: Tarassovi, Grippotyphosa, Canicola, Copenhageni, Wolffi, Hardjo, Pomona and Icterohaemorrhagiae); 19.6% for T. gondii with titer of 40. This is the first study that has identified C. burnetii in cattle associated with BoHV and BVDV, N. caninum, Leptospira spp., T. gondii and T. vivax. Thus, future studies should be conducted to investigate how widespread this pathogen is in Brazilian cattle herds.
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Affiliation(s)
- Diego Carlos Souza Zanatto
- Programa de Pós-graduação em Microbiologia Agropecuária, Universidade Estadual Paulista Júlio de Mesquita Filho - UNESP, Jaboticabal, SP, Brasil.,Departamento de Patologia Veterinária, Universidade Estadual Paulista Júlio de Mesquita Filho - UNESP, Jaboticabal, SP, Brasil
| | - Igor Renan Honorato Gatto
- Departamento de Medicina Veterinária Preventiva, Universidade Estadual Paulista Júlio de Mesquita Filho - UNESP, Jaboticabal, SP, Brasil
| | - Marcelo Bahia Labruna
- Departamento de Medicina Veterinária Preventiva e Saúde Animal, Universidade de São Paulo - USP, São Paulo, SP, Brasil
| | | | - Samir Issa Samara
- Departamento de Medicina Veterinária Preventiva, Universidade Estadual Paulista Júlio de Mesquita Filho - UNESP, Jaboticabal, SP, Brasil
| | - Rosangela Zacarias Machado
- Departamento de Patologia Veterinária, Universidade Estadual Paulista Júlio de Mesquita Filho - UNESP, Jaboticabal, SP, Brasil
| | - Marcos Rogério André
- Departamento de Patologia Veterinária, Universidade Estadual Paulista Júlio de Mesquita Filho - UNESP, Jaboticabal, SP, Brasil
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26
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Jones C. Brucellosis in an adult female from Fate Bell Rock Shelter, Lower Pecos, Texas (4000-1300 BP). INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2019; 24:252-264. [PMID: 30710889 DOI: 10.1016/j.ijpp.2019.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/20/2018] [Accepted: 01/22/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE This project is a case study discussing the differential diagnosis of multiple osteolytic vertebral lesions typical of brucellosis from an adult female from Fate Bell Rock Shelter in the Lower Pecos, Texas (4000-1300 BP). MATERIALS One middle to late adult female with exceptional preservation of the vertebrae. METHODS All skeletal remains were observed with low power magnification and the vertebrae were examined in greater detail using computed tomography (CT). RESULTS Pathological conditions involving multiple osteolytic vertebral lesions such as tuberculosis, echinococcosis, and neoplastic conditions were reviewed but brucellosis is the most likely diagnosis based on the pattern and distribution of characteristic lesions. CONCLUSIONS Aside from this study, only one other case of brucellosis has been recognized in prehistoric North American hunter-gatherer skeletal remains. SIGNIFICANCE This individual represents the first case of brucellosis in a hunter-gatherer from prehistoric North America diagnosed using both macroscopic skeletal analysis and computed tomography (CT). LIMITATIONS Poor preservation of vertebrae make cross comparison of remains and differential diagnosis difficult. SUGGESTIONS FOR FURTHER RESEARCH Further review and paleopathological research is needed regarding Coxiella burnetti (Q-fever) infection as a possible contributing factor to osteolytic lesions.
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Affiliation(s)
- Christine Jones
- Texas A&M University-Central Texas, 1001 Leadership Place, Killeen, TX, 76549, United States.
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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]
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Melenotte C, Protopopescu C, Million M, Edouard S, Carrieri MP, Eldin C, Angelakis E, Djossou F, Bardin N, Fournier PE, Mège JL, Raoult D. Clinical Features and Complications of Coxiella burnetii Infections From the French National Reference Center for Q Fever. JAMA Netw Open 2018; 1:e181580. [PMID: 30646123 PMCID: PMC6324270 DOI: 10.1001/jamanetworkopen.2018.1580] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
IMPORTANCE Q fever remains widespread throughout the world; the disease is serious and causes outbreaks and deaths when complications are not detected. The diagnosis of Q fever requires the demonstration of the presence of Coxiella burnetii and the identification of an organic lesion. OBJECTIVE To describe the hitherto neglected clinical characteristics of Q fever and identifying risk factors for complications and death. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study conducted from January 1, 1991, through December 31, 2016, included patients treated at the French National Reference Center for Q fever with serologic findings positive for C burnetii and clinical data consistent with C burnetii infection. Clinical data were prospectively collected by telephone. Patients with unavailable clinical data or an unidentified infectious focus were excluded. MAIN OUTCOMES AND MEASURES Q fever complications and mortality. RESULTS Of the 180 483 patients undergoing testing, 2918 had positive findings for C burnetii and 2434 (68.8% men) presented with clinical data consistent with a C burnetii infection. Mean (SD) age was 51.8 (17.4) years, and the ratio of men to women was 2.2. At the time of inclusion, 1806 patients presented with acute Q fever, including 138 with acute Q fever that progressed to persistent C burnetii infection, and 766 had persistent focalized C burnetii infection. Rare and hitherto neglected foci of infections included lymphadenitis (97 [4.0%]), acute Q fever endocarditis (50 [2.1%]), hemophagocytic syndrome (9 [0.4%]), and alithiasic cholecystitis (11 [0.4%]). Vascular infection (hazard ratio [HR], 3.1; 95% CI, 1.7-5.7; P < .001) and endocarditis (HR, 2.4; 95% CI, 1.1-5.1; P = .02) were associated with an increased risk of death. Independent indicators of lymphoma were lymphadenitis (HR, 77.4; 95% CI, 21.2-281.8; P < .001) and hemophagocytic syndrome (HR, 19.1; 95% CI, 3.4-108.6; P < .001). The presence of anticardiolipin antibodies during acute Q fever has been associated with several complications, including hepatitis, cholecystitis, endocarditis, thrombosis, hemophagocytic syndrome, meningitis, and progression to persistent endocarditis. CONCLUSIONS AND RELEVANCE Previously neglected foci of C burnetii infection include the lymphatic system (ie, bone marrow, lymphadenitis) with a risk of lymphoma. Cardiovascular infections were the main fatal complications, highlighting the importance of routine screening for valvular heart disease and vascular anomalies during acute Q fever. Routine screening for anticardiolopin antibodies during acute Q fever can help prevent complications. Positron emission tomographic scanning could be proposed for all patients with suspected persistent focused infection to rapidly diagnose vascular and lymphatic infections associated with death and lymphoma, respectively.
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Affiliation(s)
- Cléa Melenotte
- Aix-Marseille University, Institut de Recherche pour le Développement (IRD), Assistance Publique Hôpitaux de Marseille (APHM), Microbes, Evolution, Phylogénie et Infections, IHU (Institut Hospitalo-Universitaire)–Méditerranée Infection, Marseille, France
- French Reference Center for the Diagnosis and Study of Rickettsioses, Q Fever and Bartonelloses, IHU–Méditerranée Infection, Marseille, France
| | - Camélia Protopopescu
- Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Medicale, IRD, Sciences Economiques et Sociales de la Santé et Traitement de l’Information Médicale, Marseille, France
| | - Matthieu Million
- Aix-Marseille University, Institut de Recherche pour le Développement (IRD), Assistance Publique Hôpitaux de Marseille (APHM), Microbes, Evolution, Phylogénie et Infections, IHU (Institut Hospitalo-Universitaire)–Méditerranée Infection, Marseille, France
- French Reference Center for the Diagnosis and Study of Rickettsioses, Q Fever and Bartonelloses, IHU–Méditerranée Infection, Marseille, France
| | - Sophie Edouard
- Aix-Marseille University, Institut de Recherche pour le Développement (IRD), Assistance Publique Hôpitaux de Marseille (APHM), Microbes, Evolution, Phylogénie et Infections, IHU (Institut Hospitalo-Universitaire)–Méditerranée Infection, Marseille, France
- French Reference Center for the Diagnosis and Study of Rickettsioses, Q Fever and Bartonelloses, IHU–Méditerranée Infection, Marseille, France
| | - M. Patrizia Carrieri
- Aix-Marseille University, Institut de Recherche pour le Développement (IRD), Assistance Publique Hôpitaux de Marseille (APHM), Microbes, Evolution, Phylogénie et Infections, IHU (Institut Hospitalo-Universitaire)–Méditerranée Infection, Marseille, France
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Medicale, IRD, Sciences Economiques et Sociales de la Santé et Traitement de l’Information Médicale, Marseille, France
| | - Carole Eldin
- Aix-Marseille University, Institut de Recherche pour le Développement (IRD), Assistance Publique Hôpitaux de Marseille (APHM), Microbes, Evolution, Phylogénie et Infections, IHU (Institut Hospitalo-Universitaire)–Méditerranée Infection, Marseille, France
- French Reference Center for the Diagnosis and Study of Rickettsioses, Q Fever and Bartonelloses, IHU–Méditerranée Infection, Marseille, France
| | - Emmanouil Angelakis
- Aix-Marseille University, Institut de Recherche pour le Développement (IRD), Assistance Publique Hôpitaux de Marseille (APHM), Microbes, Evolution, Phylogénie et Infections, IHU (Institut Hospitalo-Universitaire)–Méditerranée Infection, Marseille, France
- French Reference Center for the Diagnosis and Study of Rickettsioses, Q Fever and Bartonelloses, IHU–Méditerranée Infection, Marseille, France
| | - Félix Djossou
- Unité de Maladies Infectieuses et Tropicales, Centre Hospitalier André Rosemon, Cayenne, Guyane Française
| | - Nathalie Bardin
- Aix-Marseille University, Institut de Recherche pour le Développement (IRD), Assistance Publique Hôpitaux de Marseille (APHM), Microbes, Evolution, Phylogénie et Infections, IHU (Institut Hospitalo-Universitaire)–Méditerranée Infection, Marseille, France
- Immunology Laboratory, APHM, Centre Hospitalier Universitaire Conception, Marseille, France
| | - Pierre-Edouard Fournier
- Aix-Marseille University, Institut de Recherche pour le Développement (IRD), Assistance Publique Hôpitaux de Marseille (APHM), Microbes, Evolution, Phylogénie et Infections, IHU (Institut Hospitalo-Universitaire)–Méditerranée Infection, Marseille, France
- French Reference Center for the Diagnosis and Study of Rickettsioses, Q Fever and Bartonelloses, IHU–Méditerranée Infection, Marseille, France
| | - Jean-Louis Mège
- Aix-Marseille University, Institut de Recherche pour le Développement (IRD), Assistance Publique Hôpitaux de Marseille (APHM), Microbes, Evolution, Phylogénie et Infections, IHU (Institut Hospitalo-Universitaire)–Méditerranée Infection, Marseille, France
- Immunology Laboratory, APHM, Centre Hospitalier Universitaire Conception, Marseille, France
| | - Didier Raoult
- Aix-Marseille University, Institut de Recherche pour le Développement (IRD), Assistance Publique Hôpitaux de Marseille (APHM), Microbes, Evolution, Phylogénie et Infections, IHU (Institut Hospitalo-Universitaire)–Méditerranée Infection, Marseille, France
- French Reference Center for the Diagnosis and Study of Rickettsioses, Q Fever and Bartonelloses, IHU–Méditerranée Infection, Marseille, France
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Isolation of Coxiella burnetii from an acromioclavicular infection with low serological titres. Int J Infect Dis 2018; 73:27-29. [DOI: 10.1016/j.ijid.2018.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 05/23/2018] [Accepted: 05/29/2018] [Indexed: 11/24/2022] Open
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Jandhyala D, Farid S, Mahmood M, Deziel P, Abu Saleh O, Raoult D, Beam E. Unrecognized pre-transplant disseminated Coxiella burnetti infection diagnosed in a post-transplant heart-kidney recipient. Transpl Infect Dis 2018; 20:e12962. [PMID: 29975810 DOI: 10.1111/tid.12962] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 06/20/2018] [Accepted: 06/23/2018] [Indexed: 01/17/2023]
Abstract
To the best of our knowledge, we report the first case of pre-transplant unrecognized disseminated Coxiella burnetii infection, unmasked in the post-transplant period leading to both heart and kidney allograft dysfunction. A 59 year old man with a history of simultaneous heart-kidney transplantation due to end stage heart failure from severe aortic regurgitation (AR) and cryoglobulinemic immune complex mediated concentric necrotizing glomerulonephritis (GN), presents with a history of intermittent fevers and fatigue. Prior to transplantation he was treated for multiple episodes of culture negative endocarditis requiring bio-prosthetic valve replacement. Evaluation of fever included a transesophageal echocardiogram (TEE) that revealed a large hyperechoic mass on the anterior mitral leaflet with perforation, severe mitral regurgitation and moderate AR. Blood cultures were negative at that time. Owing to development of allograft mitral and aortic valve insufficiency, he underwent allograft bio-prosthetic mitral valve (MV) replacement and aortic valvuloplasty 2 years following his transplantation. Pathologic examination of the allograft mitral valve demonstrated fibrinopurulent exudate with degenerating bacterial organisms, consistent with vegetation and myxoid degenerative changes. Due to a high suspicion for native heart C. burnetii prosthetic valve endocarditis prior to transplantation, we re-evaluated the native explanted heart histopathology, as well as the explanted allograft MV. Cardiac allograft and native MV were positive for C. burnetii by real-time PCR. C. burnetii serology was consistent with persistent infection as well.
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Affiliation(s)
- Deeksha Jandhyala
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Saira Farid
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Maryam Mahmood
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Paul Deziel
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Omar Abu Saleh
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Didier Raoult
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, UMR MEPHI, IRD, Assistance Publique-Hôpitaux de Marseille, Institut Hospitalo-Universitaire Méditerranée-Infection, Aix-Marseille Université, Marseille, France
| | - Elena Beam
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
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Gonçalves M, Moreira S, Gaspar E, Santos L. Rare case of otomastoiditis due to Coxiella burnetii chronic infection. BMJ Case Rep 2018; 2018:bcr-2018-224315. [PMID: 29680799 DOI: 10.1136/bcr-2018-224315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Q fever is a zoonotic disease caused by Coxiella burnetii that usually presents with non-specific or benign constitutional symptoms. Diagnosis is often challenging and, after acute Q fever, 1%-5% of patients can develop chronic disease. We present an 80-year-old male patient who was admitted due to a 3 months history of fever, productive cough, myalgia, weight loss, headache and hearing loss. Chronic Q fever was confirmed by positive antiphase I immunoglobulin G. Frequent locations of chronic infection was discarded, and ear CT revealed a right mastoid infection. He was treated with doxycycline and hydroxychloroquine for 18 months with significant improvement. This is a rare case of chronic Q fever presenting with otomastoiditis that has never been described.
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Affiliation(s)
- Mariana Gonçalves
- Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Sónia Moreira
- Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Elsa Gaspar
- Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Lèlita Santos
- Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Alende-Castro V, Macía-Rodríguez C, Novo-Veleiro I, García-Fernández X, Treviño-Castellano M, Rodríguez-Fernández S, González-Quintela A. Q fever in Spain: Description of a new series, and systematic review. PLoS Negl Trop Dis 2018; 12:e0006338. [PMID: 29543806 PMCID: PMC5871012 DOI: 10.1371/journal.pntd.0006338] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 03/27/2018] [Accepted: 02/23/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Forms of presentation of Q fever vary widely across Spain, with differences between the north and south. In the absence of reported case series from Galicia (north-west Spain), this study sought to describe a Q-fever case series in this region for the first time, and conduct a systematic review to analyse all available data on the disease in Spain. METHODS Patients with positive serum antibodies to Coxiella burnetii from a single institution over a 5-year period (January 2011-December 2015) were included. Patients with phase II titres above 1/128 (or documented seroconversion) and compatible clinical criterial were considered as having Q fever. Patients with clinical suspicion of chronic Q-fever and IgG antibodies to phase I-antigen of over 1/1024, or persistently high levels six months after treatment were considered to be cases of probable chronic Q-fever. Systematic review: We conducted a search of the Pubmed/Medline database using the terms: Q Fever OR Coxiella burnetii AND Spain. Our search yielded a total of 318 studies: 244 were excluded because they failed to match the main criteria, and 41 were discarded due to methodological problems, incomplete information or duplication. Finally, 33 studies were included. RESULTS A total of 155 patients, all of them from Galicia, with positive serological determination were located during the study period; 116 (75%) were deemed to be serologically positive patients without Q fever and the remaining 39 (25%) were diagnosed with Q fever. A potential exposure risk was found in 2 patients (5%). The most frequent form of presentation was pneumonia (87%), followed by isolated fever (5%), diarrhoea (5%) and endocarditis (3%). The main symptoms were headache (100%), cough (77%) and fever (69%). A trend to a paucisymptomatic illness was observed in women. Hospital admission was required in 37 cases, and 6 patients died while in hospital. Only 2 patients developed chronic Q-fever. Systematic review: Most cases were sporadic, mainly presented during the winter and spring, as pneumonia in 37%, hepatitis in 31% and isolated fever in 29.6% of patients. In the north of Spain, 71% of patients had pneumonia, 13.2% isolated fever and 13% hepatitis. In the central and southern areas, isolated fever was the most frequent form of presentation (40%), followed by hepatitis (38.4%) and pneumonia (17.6%). Only 31.7% of patients reported risk factors, and an urban-environment was the most frequent place of origin. Overall mortality was 0.9%, and the percentage of patients with chronic forms of Q-fever was 2%. CONCLUSIONS This is the first study to report on a Q-fever case series in Galicia. It shows that in this region, the disease affects the elderly population -even in the absence of risk factors- and is linked to a higher mortality than reported by previous studies. While pneumonia is the most frequent form of presentation in the north of the country, isolated fever and hepatitis tend to be more frequent in the central and southern areas. In Spain, 32% of Q-fever cases do not report contact with traditional risk factors, and around 58% live in urban areas.
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Affiliation(s)
- Vanesa Alende-Castro
- Department of Internal Medicine, University Teaching Hospital, Santiago de Compostela, A Coruña, Spain
| | | | - Ignacio Novo-Veleiro
- Department of Internal Medicine, University Teaching Hospital, Santiago de Compostela, A Coruña, Spain
| | - Xana García-Fernández
- Department of Microbiology, University Teaching Hospital, Santiago de Compostela, A Coruña, Spain
| | | | | | - Arturo González-Quintela
- Department of Internal Medicine, University Teaching Hospital, Santiago de Compostela, A Coruña, Spain
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Abstract
Coxiella burnetii is the causative pathogen of the zoonotic infection Q fever. Most patients with Q fever experience a non-specific febrile illness, hepatitis or pneumonia. Q fever has recently been described as a cause of prosthetic joint septic arthritis, but remains very uncommonly reported. We present a case of Q fever prosthetic joint septic arthritis that has responded to a combination of two-stage surgical exchange and prolonged medical treatment with doxycycline and hydroxychloroquine.
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Affiliation(s)
- Scott Weisenberg
- Alta Bates Summit Medical Center â€" Summit Campus, Oakland, California, USA
| | - David Perlada
- Alta Bates Summit Medical Center â€" Summit Campus, Oakland, California, USA
| | - Thomas Peatman
- Alta Bates Summit Medical Center â€" Summit Campus, Oakland, California, USA
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Kouijzer IJE, Kampschreur LM, Wever PC, Hoekstra C, van Kasteren MEE, de Jager-Leclercq MGL, Nabuurs-Franssen MH, Wegdam-Blans MCA, Ammerlaan HSM, Buijs J, Geus-Oei LFD, Oyen WJG, Bleeker-Rovers CP. The Value of 18F-FDG PET/CT in Diagnosis and During Follow-up in 273 Patients with Chronic Q Fever. J Nucl Med 2017; 59:127-133. [PMID: 28546336 DOI: 10.2967/jnumed.117.192492] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 05/22/2017] [Indexed: 12/26/2022] Open
Abstract
In 1%-5% of all acute Q fever infections, chronic Q fever develops, mostly manifesting as endocarditis, infected aneurysms, or infected vascular prostheses. In this study, we investigated the diagnostic value of 18F-FDG PET/CT in chronic Q fever at diagnosis and during follow-up. Methods: All adult Dutch patients suspected of chronic Q fever who were diagnosed since 2007 were retrospectively included until March 2015, when at least one 18F-FDG PET/CT scan was obtained. Clinical data and results from 18F-FDG PET/CT at diagnosis and during follow-up were collected. 18F-FDG PET/CT scans were prospectively reevaluated by 3 nuclear medicine physicians using a structured scoring system. Results: In total, 273 patients with possible, probable, or proven chronic Q fever were included. Of all 18F-FDG PET/CT scans performed at diagnosis, 13.5% led to a change in diagnosis. Q fever-related mortality rate in patients with and without vascular infection based on 18F-FDG PET/CT was 23.8% and 2.1%, respectively (P = 0.001). When 18F-FDG PET/CT was added as a major criterion to the modified Duke criteria, 17 patients (1.9-fold increase) had definite endocarditis. At diagnosis, 19.6% of 18F-FDG PET/CT scans led to treatment modification. During follow-up, 57.3% of 18F-FDG PET/CT scans resulted in treatment modification. Conclusion:18F-FDG PET/CT is a valuable technique in diagnosis of chronic Q fever and during follow-up, often leading to a change in diagnosis or treatment modification and providing important prognostic information on patient survival.
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Affiliation(s)
- Ilse J E Kouijzer
- Division of Infectious Diseases, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands .,Radboud Expert Centre for Q Fever, Radboud University Medical Center, Nijmegen, The Netherlands.,MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Linda M Kampschreur
- Department of Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter C Wever
- Department of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Corneline Hoekstra
- Department of Nuclear Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Marjo E E van Kasteren
- Department of Internal Medicine, Elisabeth Tweesteden Hospital, Tilburg, The Netherlands
| | | | - Marrigje H Nabuurs-Franssen
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Marjolijn C A Wegdam-Blans
- Department of Medical Microbiology, Laboratory for Pathology and Medical Microbiology (PAMM), Veldhoven, The Netherlands
| | - Heidi S M Ammerlaan
- Department of Internal Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - Jacqueline Buijs
- Department of Internal Medicine, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Lioe-Fee de Geus-Oei
- MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.,Department of Nuclear Medicine, Leiden University Medical Center, Leiden, The Netherlands; and
| | - Wim J G Oyen
- Institute of Cancer Research/Royal Marsden Hospital, London, U.K., and Department of Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Chantal P Bleeker-Rovers
- Division of Infectious Diseases, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Expert Centre for Q Fever, Radboud University Medical Center, Nijmegen, The Netherlands
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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: 539] [Impact Index Per Article: 77.0] [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.
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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
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