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de La Porte des Vaux C, Sainte-Rose V, Le Turnier P, Djossou F, Nacher M, Zappa M, Epelboin L. Chest CT findings in community-acquired pneumonia due to Coxiella burnetii (Q fever) compared to Streptococcus pneumoniae, a cross sectional study in French Guiana, 2013-2017. Travel Med Infect Dis 2024; 57:102679. [PMID: 38135242 DOI: 10.1016/j.tmaid.2023.102679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/29/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVES Few and small studies previously examined chest CT-scan characteristics of Coxiella burnetii (Cb) community-acquired pneumonia (CAP). Larger studies are needed to guide physicians towards diagnosis of Q fever in case of pneumonia. METHODS We conducted a single-center retrospective observational study between 2013 and 2017. All patients with Cb or Streptococcus pneumoniae (Sp) CAP who had a chest CT-scan on admission at Cayenne Hospital (French Guiana) were included. Chest CT-scan were all analyzed by the same expert radiologist. RESULTS We included 75 patients with Cb CAP and 36 with Sp CAP. Fifty-nine percent of all patients were men (n = 66) and median age was 52 [IQR = 38-62]. Chest CT-scans of Cb CAP patients revealed 67 alveolar condensations (89 %), 52 ground-glass opacities (69 %), 30 cases of lymphadenopathy(ies) (40 %) and 25 pleural effusions (33 %). Parenchyma lesions caused by Cb were predominantly unilateral (67 %). We found high numbers of alveolar condensations in both Cb and Sp CAP (89 % and 75 %; respectively), but the presence of ground-glass opacities was significantly associated with Cb CAP (69 % versus 30 %; p < 0.01). Cb CAP were associated with more lymphadenopathies (40 % vs 17 %; p = 0.01) while Sp CAP showed more bronchial thickening (19 % versus 3 %; p < 0.01) and (micro)nodule(s) ≤1 cm (25 % vs 3 %, p < 0.01). CONCLUSIONS This large study shows that the most typical aspect of chest CT-scan in case of Cb CAP in French Guiana is a unilateral alveolar consolidation associated with ground glass opacities and lymphadenopathies. C. burnetti and S. pneumoniae both most often cause alveolar consolidations, but present some significantly different CT-scan patterns. This could help physicians through therapeutic choices.
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Affiliation(s)
- Clémentine de La Porte des Vaux
- Department of Infectious and Tropical Diseases, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana; Department of Infectious and Tropical Diseases, Hôpital Universitaire Necker-Enfants malades, Paris, France.
| | - Vincent Sainte-Rose
- Department of Microbiology, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Paul Le Turnier
- Department of Infectious and Tropical Diseases, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Félix Djossou
- Department of Infectious and Tropical Diseases, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Mathieu Nacher
- CIC INSERM 1424, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Magaly Zappa
- Department of Radiology, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Loïc Epelboin
- Department of Infectious and Tropical Diseases, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana; CIC INSERM 1424, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
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2
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O'Gorman P, Nair L, Kisiel N, Hughes I, Huang K, Hsu CCT, Fagman E, Heying R, Pizzi MN, Roque A, Singh K. Meta-analysis assessing the sensitivity and specificity of 18F-FDG PET/CT for the diagnosis of prosthetic valve endocarditis (PVE) using individual patient data (IPD). Am Heart J 2023; 261:21-34. [PMID: 36934977 DOI: 10.1016/j.ahj.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 02/27/2023] [Accepted: 03/12/2023] [Indexed: 05/26/2023]
Abstract
IMPORTANCE The use of 18F-FDG PET/CT in diagnostic algorithms for PVE has increased since publication of studies and guidelines advocating its use. The assessment of test accuracy has been limited by small study sizes. We undertook a systematic review using individual patient data (IPD) meta-analysis techniques. OBJECTIVE To estimate the summary sensitivity and specificity of 18F-FDG PET/CT in diagnosing PVE. We also assessed the effect of patient factors on test accuracy as defined by changes in the odds ratios associated with each factor. The effect of the PET/CT study on the final diagnosis was also assessed when compared to the preliminary Duke classification to determine in which patient group 18F-FDG PET/CT had the greatest utility. STUDY SELECTION Studies were included if PET/CT was performed for suspicion of PVE and IPD of both the PET/CT result and final diagnosis defined by a gold-standard assessment was available. There were 3 possible final diagnoses ("definite PVE," "possible PVE," and "rejected PVE"). RESULTS Seventeen studies were included with IPD available for 537 patients (from 538 scans). The summary sensitivity and specificity were 85% (95% CI 74.2%-91.8%) and 86.5% (95% CI 75.8%-92.9%) respectively when patients with final diagnosis of "possible PVE" were classified as positive for PVE. When this group was classified as negative for PVE, sensitivity was 87.4% (95% CI 80.4%-92.1%) and specificity was 84.9% (95% CI 71.5%-92.6%). Patients with a known pathogen (especially coagulase negative staphylococcal species), elevated CRP, a biological or aortic valve infection appeared more likely to have an accurate PET/CT diagnosis. Those with a mechanical valve, prior antibiotic treatment or a transcatheter aortic valve replacement valve were less likely to have an accurate test. Time since valve implantation and the presence of surgical adhesive did not appear to affect test accuracy. Of the patients with a preliminary Duke classification of "possible PVE," 84% received a more conclusive final diagnosis of "definite" or "rejected" PVE after the PET/CT study. CONCLUSIONS AND RELEVANCE 18F-FDG PET/CT has high sensitivity and specificity in diagnosing PVE and the diagnostic utility is greatest in patients with a preliminary Duke classification of "possible PVE." Some patient factors appear to affect test accuracy, though these results should be interpreted with caution given low patient numbers for subgroup analyses.
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Affiliation(s)
- Patricia O'Gorman
- Medical Imaging Department, Gold Coast University Hospital (Queensland Health), Southport, Australia.
| | - Lawrence Nair
- Department of Cardiothoracic Surgery, The Prince Charles Hospital (Queensland Health), Brisbane, Australia
| | - Nadya Kisiel
- Department of Nuclear Medicine, Royal Brisbane and Women's Hospital (Queensland Health), Brisbane, Australia
| | - Ian Hughes
- Office for Research Governance and Development (Biostatistics), Gold Coast University Hospital (Queensland Health), Southport, Australia; School of Medicine, The University of Queensland, Brisbane, Australia
| | - Karen Huang
- Medical Imaging Department, Gold Coast University Hospital (Queensland Health), Southport, Australia
| | - Charlie Chia-Tsong Hsu
- Medical Imaging Department, Gold Coast University Hospital (Queensland Health), Southport, Australia
| | - Erika Fagman
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ruth Heying
- Pediatric Cardiology, University Hospitals Leuven, Belgium
| | - María N Pizzi
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Albert Roque
- Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; Institut de Diagnòstic per la Imatge (IDI), Barcelona, Spain; Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Kuljit Singh
- Cardiology Department, Gold Coast University Hospital (Queensland Health), Southport, Australia
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3
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Wang D, Zhang L, Cai Z, Liu Y. Diagnosis of Acute Q Fever in a Patient by Using Metagenomic Next-Generation Sequencing: A Case Report. Infect Drug Resist 2023; 16:1923-1930. [PMID: 37025192 PMCID: PMC10072143 DOI: 10.2147/idr.s405697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 03/23/2023] [Indexed: 04/03/2023] Open
Abstract
Background Q fever is a zoonotic disease caused by Coxiella burnetii infection, with domestic ruminants as the main source of infection and tick bites as one of the transmission vectors. The clinical manifestations of Q fever are varied and atypical. For the reason that C. burnetii is a strictly intracellular pathogen, it is difficult to be diagnosed by traditional culture methods. Additionally, serological and molecular diagnostic methods to assist in the diagnosis of Q fever are not routinely performed in most clinical laboratories. Therefore, early and rapid diagnosis of Q fever is a challenge. Case Presentation In the present study, a 34-year-old male patient presented with an acute onset and symptoms such as high fever, lethargy, pulmonary infection, and liver damage. In addition, he had a history of tick bites. Despite conducting relevant laboratory and radiological examinations, the etiology remained unknown. Subsequently, we detected the sequence reads of C. burnetii in a venous blood sample using metagenomic next-generation sequencing (mNGS), and the symptoms of patients were significantly improved after timely treatment with the special drug tetracycline. To our knowledge, this is the first report of Q fever associated with C. burnetii detected directly from venous blood sample in Wuhan, China. Conclusion Metagenomic next-generation sequencing is a new diagnostic technology that provides rapid and accurate detection of unexplained infections, including Q fever. Its application plays a crucial role in clinical diagnosis for identifying elusive pathogens.
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Affiliation(s)
- Dong Wang
- Department of Clinical Laboratory, Wuhan Asia General Hospital, Wuhan Asia General Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, Hubei Province, 430056, People’s Republic of China
| | - Litao Zhang
- Department of Clinical Laboratory, Wuhan Asia General Hospital, Wuhan Asia General Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, Hubei Province, 430056, People’s Republic of China
| | - Zhifang Cai
- Pulmonary and Critical Care Medicine, Hankou Hospital of Wuhan, Hankou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, Hubei Province, 430012, People’s Republic of China
| | - Yumei Liu
- Pulmonary and Critical Care Medicine, Hankou Hospital of Wuhan, Hankou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, Hubei Province, 430012, People’s Republic of China
- Correspondence: Yumei Liu, Email
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4
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Kouijzer IJE, Van der Jagt MFP, Bleeker-Rovers CP, Dirven M, de Mast Q, Poyck PP. OUTCOME IN PATIENTS AFTER AUTOLOGOUS FEMORAL VEIN RECONSTRUCTION FOR PRIMARY AORTIC INFECTION AND AORTIC GRAFT INFECTION: A CASE SERIES. Ann Vasc Surg 2021; 83:240-250. [PMID: 34933108 DOI: 10.1016/j.avsg.2021.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES For surgical treatment of primary aortic infection and aortic graft infection, in situ reconstruction with autologous vein(s) has the lowest rates of re-infection and of graft thrombosis. In this study, we have assessed the outcome after autologous femoral vein reconstruction in patients with aortic (graft) infection and we provide insights into the specific technical surgical considerations of the procedure. METHODS In this retrospective single-center study, all patients who underwent autologous femoral vein reconstruction because of primary aortic infection or aortic graft infection between January 2012 and January 2020 were included. The primary outcome parameter was 30-day mortality. RESULTS Twenty-nine patients with autologous femoral vein reconstruction for a primary aortic infection (n = 3) or aortic graft infection (n = 26) were included. An aorto-enteral fistula was detected in 13 patients (49%). Venous reconstruction of the aorta was performed with a single femoral vein in 17 patients (59%), and two femoral veins in 12 patients (41%). Thirty-day mortality was 17%. Relapse of infection occurred in two patients (7%) and no amputations were needed. One year after surgery, only three patients (10%) still needed stockings and after two years none of the patients used stockings. CONCLUSIONS Central aortic reconstruction with femoral veins is a durable solution for primary aortic and aortoiliac graft infections with a low incidence of reinfections, amputations, and venous hypertension.
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Affiliation(s)
- Ilse J E Kouijzer
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Michel F P Van der Jagt
- Department of Vascular Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Chantal P Bleeker-Rovers
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mark Dirven
- Department of Vascular Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Quirijn de Mast
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Paul Pc Poyck
- Department of Vascular Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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5
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Markowich AH, Romani L, Leccisotti L, De Luca M. Challenging case of chronic Q fever endocarditis: usefulness of 18F-FDG PET/CT in the diagnosis and follow-up. BMJ Case Rep 2021; 14:e243290. [PMID: 34417234 PMCID: PMC8381325 DOI: 10.1136/bcr-2021-243290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2021] [Indexed: 11/03/2022] Open
Abstract
Diagnosis of infective endocarditis can be challenging for clinicians, especially when involving prosthetic valves. Recent data suggest that 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) could be a useful diagnostic tool in this setting. Here, we report a case of a patient with an aortic biological prosthesis who presented with a history of fever and fatigue. Echocardiograms were negative for vegetations. The 18F-FDG PET/CT revealed an infective process of the valve and serological tests were positive for chronic Coxiella burnetii infection. Specific treatment for chronic Q fever endocarditis was, therefore, started and the response was monitored using 18F-FDG PET/CT. This case highlights the challenges and pitfalls clinicians face when confronted with prosthetic valve endocarditis and the use of 18F-FDG PET/CT for diagnosis and follow-up.
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Affiliation(s)
- Anna Hermine Markowich
- Immunology and Infectious Diseases Unit, Academic Department of Pediatrics, IRCCS Ospedale Pediatrico Bambino Gesù, Roma, Lazio, Italy
| | - Lorenza Romani
- Immunology and Infectious Diseases Unit, Academic Department of Pediatrics, IRCCS Ospedale Pediatrico Bambino Gesù, Roma, Lazio, Italy
| | - Lucia Leccisotti
- UOC di Medicina Nucleare, Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Roma, Lazio, Italy
| | - Maia De Luca
- Immunology and Infectious Diseases Unit, Academic Department of Pediatrics, IRCCS Ospedale Pediatrico Bambino Gesù, Roma, Lazio, Italy
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6
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Miller HK, Priestley RA, Kersh GJ. Q Fever: A troubling disease and a challenging diagnosis. CLINICAL MICROBIOLOGY NEWSLETTER 2021; 43:109-118. [PMID: 37701818 PMCID: PMC10493821 DOI: 10.1016/j.clinmicnews.2021.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
Q fever is a disease caused by the bacterial pathogen Coxiella burnetii. This hardy organism can easily spread long distances in the wind, and only a few infectious aerosolized particles are necessary to cause serious illness. Presentations of Q fever disease can be wide-ranging, allowing it to masquerade as other illnesses and highlight the importance of laboratory testing for diagnosis and treatment. This review summarizes Q fever's epidemiology and clinical presentations and presents classical laboratory diagnostic assays and novel approaches to detecting this troubling disease.
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Affiliation(s)
- Halie K. Miller
- Centers for Disease Control and Prevention, Atlanta, Georgia
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7
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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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8
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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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Splenic uptake on FDG PET/CT correlates with Kikuchi-Fujimoto disease severity. Sci Rep 2021; 11:10836. [PMID: 34035381 PMCID: PMC8149816 DOI: 10.1038/s41598-021-90350-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 04/26/2021] [Indexed: 12/22/2022] Open
Abstract
Kikuchi-Fujimoto disease (KFD) is usually self-limiting, but prolonged systemic symptoms often result in frequent hospital visits, long admission durations, or missed workdays. We investigated the role of fluorine-18 fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in assessing KFD severity. We reviewed the records of 31 adult patients with pathologically confirmed KFD who underwent 18F-FDG PET/CT between November 2007 and April 2018 at a tertiary-care referral hospital. Disease severity was assessed using criteria based on clinical manifestations of advanced KFD. Systemic activated lymph nodes and severity of splenic activation were determined using semi-quantitative and volumetric PET/CT parameters. The median of the mean splenic standardized uptake value (SUVmean) was higher in patients with severe KFD than those with mild KFD (2.38 ± 1.18 vs. 1.79 ± 0.99, p = 0.058). Patients with severe KFD had more systemically activated volume and glycolytic activity than those with mild KFD (total lesion glycolysis: 473.5 ± 504.4 vs. 201.6 ± 363.5, p = 0.024). Multivariate logistic regression showed that myalgia (odds ratio [OR] 0.035; 95% confidence interval [CI] 0.001–0.792; p = 0.035), total lymph node SUVmax (cutoff 9.27; OR 24.734; 95% CI 1.323–462.407; p = 0.032), and spleen SUVmean (cutoff 1.79; OR 37.770; 95% CI 1.769–806.583; p = 0.020) were significantly associated with severe KFD. 18F-FDG PET/CT could be useful in assessing KFD severity.
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Ricciardi E, Moscatelli A, Berruti M, Donegani MI, Mikulska MK, Pende A. 18F-Fluorodeoxyglucose positron emission tomography/computed tomography as a diagnostic and follow-up tool in Coxiella burnetii endocarditis of prosthetic valve and aortic valved tube: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytab159. [PMID: 34027304 PMCID: PMC8127028 DOI: 10.1093/ehjcr/ytab159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/26/2020] [Accepted: 04/09/2021] [Indexed: 11/14/2022]
Abstract
Background European Society of Cardiology 2015 guidelines approved 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) as a useful diagnostic imaging technique in prosthetic valve endocarditis (PVE) and recent evidence seems to suggest a role of nuclear imaging in the follow-up of cardiovascular infections, but nowadays there are no sufficient data available. Case summary A 67-year-old male presented with fever, weight loss, and fatigue. His medical history included ulcerative colitis and a previous Bentall-De Bono surgical procedure in 2014. A previous recent hospitalization to a small community hospital did not reveal a clear aetiology for the fever: transeosophageal echocardiography showed dubious peri-prosthetic tissue alterations, interpreted as post-surgical fibrosis; consequently, the patient was discharged with steroid therapy. At admission in our ward, we repeated transoesophageal echocardiography that confirmed the peri-prosthetic alterations. Moreover, 18F-FDG PET/CT showed two hypermetabolic areas, one around the prosthetic tube in the aortic bulb and the other in relation with the prosthetic aortic valve. Serological test was positive for Coxiella burnetii infection with consequent beginning of a targeted antimicrobial therapy with oral doxicycline and hydroxychloroquine. Echocardiography, serology, and 18F-FDG PET/CT follow-up demonstrated a progressive response to treatment and clinical conditions of the patient gradually improved. Discussion According to guidelines, 18F-FDG PET/CT can be used in ambiguous PVE to improve diagnostic accuracy of standard techniques. In this case, 18F-FDG PET/CT combined with echocardiography and serological tests is used not only to better define diagnosis but also for treatment response monitoring during follow-up.
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Affiliation(s)
- Elisa Ricciardi
- Clinic of Emergency Medicine, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessandro Moscatelli
- Division of Gastroenterology and Digestive Endoscopy, Hospital of Lavagna ASL4 Chiavarese, Lavagna, Italy
| | - Marco Berruti
- Clinic of Infective Diseases, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maria Isabella Donegani
- Division of Nuclear Medicine, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Aldo Pende
- Clinic of Emergency Medicine, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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11
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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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12
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Ghanem-Zoubi N, Karram T, Kagna O, Merhav G, Keidar Z, Paul M. Q fever vertebral osteomyelitis among adults: a case series and literature review. Infect Dis (Lond) 2021; 53:231-240. [PMID: 33475036 DOI: 10.1080/23744235.2020.1871508] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Q fever osteoarticular infections are a rare complication of the chronic form of Q fever. We aimed to characterize chronic Q fever vertebral osteomyelitis through our experience and a review of the literature. METHODS Four adult patients with Q fever vertebral osteomyelitis diagnosed in a tertiary hospital in northern Israel between 2016 to 2020 are described. In addition, a 30 years' literature review of Q fever vertebral osteomyelitis, characterizing predisposing factors, clinical presentation, course of disease, treatment and outcomes, was performed. RESULTS Thirty-four adult patients with Q fever vertebral osteomyelitis were identified. The vast majority were male (30/34, 88%) with a mean age of 67.2 ± 10 years. Involvement of the adjacent aorta, likely the origin of the infection, was observed in 23/34 (68%) of the patients, usually among patients with aortic graft or aneurysm. Clinical presentation was insidious and fever was frequently absent. Delayed diagnosis for months to years after symptoms onset was frequently reported. Vascular infections were managed with or without extraction of the infected aneurysm/aorta and graft placement. The outcome was variable with limited follow-up data in most cases. Patients were usually treated with prolonged antimicrobial therapy, most commonly doxycycline and hydroxychloroquine combination therapy. CONCLUSION Q fever should be included in the differential diagnosis of vertebral osteomyelitis in endemic settings, in particular when concomitant adjacent vascular infection exists.
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Affiliation(s)
- Nesrin Ghanem-Zoubi
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Tony Karram
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.,Department of Vascular Surgery, Rambam Medical Center, Haifa, Israel
| | - Olga Kagna
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.,Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel
| | - Goni Merhav
- Department of Radiology, Rambam Health Care Campus, Haifa, Israel
| | - Zohar Keidar
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.,Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel
| | - Mical Paul
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
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13
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Han YH, Hwang JH, Lee CS. Pre- and Posttreatment Findings of F-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in a Case of Acute Q Fever. Am J Trop Med Hyg 2020; 102:1168-1169. [PMID: 32519650 PMCID: PMC7253120 DOI: 10.4269/ajtmh.20-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Yeon-Hee Han
- Cyclotron Research Center, Molecular Imaging and Therapeutic Medicine Research Center, Jeonbuk National University Medical School and Hospital, Jeonju, Republic of Korea.,Department of Nuclear Medicine, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Joo-Hee Hwang
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea.,Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Chang-Seop Lee
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea.,Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju, Republic of Korea
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14
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Domingues CM, Ferreira MJ, Silva R, Gonçalves V, Silva AM, Gonçalves L. 18F-FDG-PET/CT in diagnosis of Q fever endocarditis. J Nucl Cardiol 2020; 27:1407-1411. [PMID: 31119713 DOI: 10.1007/s12350-019-01750-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 04/11/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Célia Marques Domingues
- Department of Cardiology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal.
| | - Maria João Ferreira
- Department of Cardiology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
- Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
- Instituto de Ciências Nucleares Aplicadas à Saúde (ICNAS), Universidade de Coimbra, Coimbra, Portugal
| | - Rodolfo Silva
- Instituto de Ciências Nucleares Aplicadas à Saúde (ICNAS), Universidade de Coimbra, Coimbra, Portugal
- Department of Nuclear Medicine, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Valdirene Gonçalves
- Department of Cardiology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - António Marinho Silva
- Department of Pediatric Cardiology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Lino Gonçalves
- Department of Cardiology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
- Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
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15
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van den Brom R, de Jong A, van Engelen E, Heuvelink A, Vellema P. Zoonotic risks of pathogens from sheep and their milk borne transmission. Small Rumin Res 2020; 189:106123. [PMID: 32427176 PMCID: PMC7227596 DOI: 10.1016/j.smallrumres.2020.106123] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 04/23/2020] [Accepted: 04/23/2020] [Indexed: 02/07/2023]
Abstract
Sheep were domesticated around 9000 BC in the Middle East, and since then milk from sheep gradually became very popular, not only for drinking but also for making cheeses and other dairy products. Nowadays, these dairy products are also important for people with an allergy to cow milk, and these products are an essential part of the local daily diet in regions of the world that are not suitable for cows and goats. Consumption of raw milk and raw milk products has a zoonotic risk, and with regard to sheep, the main pathogens associated with such dairy products are: Brucella melitensis, Campylobacter spp., Listeria spp., Salmonella spp., Shiga-toxin producing Escherichia coli, Staphylococcus aureus, tick borne encephalitis virus, and Toxoplasma gondii. Especially, young children, elderly people, pregnant women and immunocompromised (YOPI) persons, and those suffering from disease should be aware of the risk of consuming raw milk and raw milk products. This latter risk can be reduced by proper flock health management, prevention of contamination during milking, adequate milk processing, transport, and refrigerated storage. Only processes equaling pasteurization sufficiently reduce zoonotic risks from milk and milk products, but proper cooling is essential and recontamination must be prevented. Therefore, strict hygiene practices throughout the production process and supply chain especially for raw milk and raw dairy products, should be applied. Small scale production systems pose a greater risk compared to industrialized production systems because of a less protocolized and controlled production process. This manuscript describes zoonotic risks of pathogens from sheep and their milk borne transmission. Additionally, routes of contamination, possibilities for multiplication, and prevention measures thereof are described. We summarize some major human outbreaks caused by consumption of sheep milk and products made thereof, and finally discuss their implications.
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Affiliation(s)
- René van den Brom
- Royal GD, Department of Small Ruminant Health, Deventer, The Netherlands
| | - Aarieke de Jong
- Netherlands Food and Consumer Product Safety Authority, Office for Risk Assessment and Research (NVWA-BuRO), Utrecht, The Netherlands
| | - Erik van Engelen
- Royal GD, Department of Research and Development, Deventer, The Netherlands
| | - Annet Heuvelink
- Royal GD, Department of Research and Development, Deventer, The Netherlands
| | - Piet Vellema
- Royal GD, Department of Small Ruminant Health, Deventer, The Netherlands
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16
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Abstract
Neuroblastoma is one of the most common pediatric malignant tumors. Functional imaging plays an important role in the diagnosis, staging, and therapy response monitoring of neuroblastoma. Although metaiodobenzylguanidine scan with single-photon emission computed tomography/computed tomography remains the mainstay in functional imaging of the neuroblastomas, PET/CT has begun to show increased utility in this clinical setting.
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17
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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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18
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Spaziante M, Franchi C, Taliani G, D'Avolio A, Pietropaolo V, Biliotti E, Esvan R, Venditti M. Serum Bactericidal Activity Levels Monitor to Guide Intravenous Dalbavancin Chronic Suppressive Therapy of Inoperable Staphylococcal Prosthetic Valve Endocarditis: A Case Report. Open Forum Infect Dis 2019; 6:ofz427. [PMID: 31737736 PMCID: PMC6847610 DOI: 10.1093/ofid/ofz427] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 09/25/2019] [Indexed: 12/21/2022] Open
Abstract
Here we describe a case of a methicillin-resistant coagulase-negative staphylococci prosthetic valve endocarditis in a patient considered not eligible for valve replacement due to high perioperative mortality risk and who did not tolerate oral antibiotic treatment. Under these circumstances, intravenous long-term chronic suppressive antibiotic therapy with dalbavancin, scheduling the doses using the serum bactericidal activity titers, proved to be safe and effective.
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Affiliation(s)
- Martina Spaziante
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy
| | - Cristiana Franchi
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Gloria Taliani
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Antonio D'Avolio
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Valeria Pietropaolo
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy
| | - Elisa Biliotti
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Rozenn Esvan
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy
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19
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Stern Shavit S, Bernstine H, Sopov V, Nageris B, Hilly O. FDG-PET/CT for diagnosis and follow-up of necrotizing (malignant) external otitis. Laryngoscope 2018; 129:961-966. [PMID: 30549258 DOI: 10.1002/lary.27526] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Imaging is important for the diagnosis and follow-up of necrotizing external otitis (NEO). The best imaging modality is controversy. To suggest 2-deoxy-2-[fluorine-18] fluoro-D-glucose-positron emission tomography/computed tomography (18F-FDG-PET/CT) as an alternative to technetium-99m and gallium-67 scans for diagnosis and assessment of response to treatment for patients with NEO. STUDY DESIGN Case series. METHODS Tertiary referral center. From 2013 through 2017, 12 patients were diagnosed with NEO based on clinical features and positive FDG uptake within the temporal bone on PET/CT. Mean age was 74 ± 11.5; 83% of the patients were male; and 83% had diabetes. RESULTS PET/CT scans were reviewed independently by two nuclear medicine specialists. Imaging located osteomyelitis in external ear canal, mastoid, temporomandibular joint, and nasopharyngeal region (100%, 50%, 16%, 8%, respectively). Mean follow-up was 16 months. Eight patients (67%) underwent a second PET/CT scan after active otitis resolved and after at least 6 weeks of antibiotic treatment. The scan demonstrated no or substantially reduced FDG uptake and treatment was stopped. The patients had no NEO symptoms at the end of follow-up. One patient had significant uptake, and antibiotic treatment was continued until a third scan demonstrated no FDG uptake. Two patients died before the second PET/CT, and two were lost to follow-up. CONCLUSION 18F-FDG-PET/CT is a reliable imaging modality for diagnosis, disease localization, and decision making regarding treatment cessation. 18F-FDG-PET/CT should be considered as the imaging modality of choice for initial diagnosis and follow-up in NEO patients. Larger, controlled studies are warranted. LEVEL OF EVIDENCE 4 Laryngoscope, 129:961-966, 2019.
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Affiliation(s)
- Sagit Stern Shavit
- Department of Otolaryngology-Head and Neck Surgery, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hanna Bernstine
- Department of Nuclear Medicine, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Vladimir Sopov
- Department of Nuclear Medicine, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ben Nageris
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Otolaryngology-Head and Neck Surgery, Meir Medical Center, Kfar Saba, Israel
| | - Ohad Hilly
- Department of Otolaryngology-Head and Neck Surgery, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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20
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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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21
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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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22
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Vascular infection with outside-in vertebral destruction in chronic Q fever. THE LANCET. INFECTIOUS DISEASES 2018; 18:603. [PMID: 29856356 DOI: 10.1016/s1473-3099(18)30272-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 04/16/2018] [Indexed: 11/21/2022]
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