RESUMEN
Q fever prosthetic valve endocarditis in association with antiphospholipid antibody syndrome (APS) in systemic lupus erythematosus (SLE) has not been previously reported. Here, we report a 22-year-old Saudi female diagnosed with SLE and APS. She had mitral valve replacement with bio-prosthesis five years earlier for Libman-Sack endocarditis. She presented with two months' history of fever, cough, palpitations, and progressive shortness of breath. A transthoracic echocardiogram showed a degenerative mitral valve prosthesis with a large mass causing severe obstruction. Open heart surgery revealed multiple masses on the mitral valve. PCR from the resected tissues was positive for Coxiella burnetii DNA. Q fever serology showed phase two IgG 1:2048, phase one IgG 1:512, and IgM 1:1024. The valve was replaced with a bio-prosthesis. She was well at 12 months of follow-up.
Asunto(s)
Síndrome Antifosfolípido/complicaciones , Bioprótesis/efectos adversos , Endocarditis Bacteriana/diagnóstico , Prótesis Valvulares Cardíacas/efectos adversos , Lupus Eritematoso Sistémico/complicaciones , Fiebre Q/diagnóstico , Procedimientos Quirúrgicos Cardíacos , Coxiella burnetii/aislamiento & purificación , ADN Bacteriano/aislamiento & purificación , Ecocardiografía , Endocarditis Bacteriana/cirugía , Femenino , Implantación de Prótesis de Válvulas Cardíacas , Humanos , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/patología , Estenosis de la Válvula Mitral/complicaciones , Estenosis de la Válvula Mitral/cirugía , Reacción en Cadena de la Polimerasa , Fiebre Q/cirugía , Resultado del Tratamiento , Adulto JovenAsunto(s)
Endocarditis/complicaciones , Fiebre Q/complicaciones , Hemorragia Retiniana/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica , Calcinosis/diagnóstico , Calcinosis/microbiología , Coxiella burnetii/aislamiento & purificación , Endocarditis/cirugía , Fondo de Ojo , Humanos , Masculino , Persona de Mediana Edad , Fiebre Q/cirugía , Hemorragia Retiniana/etiologíaRESUMEN
OBJECTIVE: After primary infection with Coxiella burnetii, patients may develop acute Q fever, which is a relatively mild disease. A small proportion of patients (1%-5%) develop chronic Q fever, which is accompanied by high mortality and can be manifested as infected arterial or aortic aneurysms or infected vascular prostheses. The disease can be complicated by arterial fistulas, which are often fatal if they are left untreated. We aimed to assess the cumulative incidence of arterial fistulas and mortality in patients with proven chronic Q fever. METHODS: In a retrospective, observational study, the cumulative incidence of arterial fistulas (aortoenteric, aortobronchial, aortovenous, or arteriocutaneous) in patients with proven chronic Q fever (according to the Dutch Chronic Q Fever Consensus Group criteria) was assessed. Proven chronic Q fever with a vascular focus of infection was defined as a confirmed mycotic aneurysm or infected prosthesis on imaging studies or positive result of serum polymerase chain reaction for C. burnetii in the presence of an arterial aneurysm or vascular prosthesis. RESULTS: Of 253 patients with proven chronic Q fever, 169 patients (67%) were diagnosed with a vascular focus of infection (42 of whom had a combined vascular focus and endocarditis). In total, 26 arterial fistulas were diagnosed in 25 patients (15% of patients with a vascular focus): aortoenteric (15), aortobronchial (2), aortocaval (4), and arteriocutaneous (5) fistulas (1 patient presented with both an aortocaval and an arteriocutaneous fistula). Chronic Q fever-related mortality was 60% for patients with and 21% for patients without arterial fistula (P < .0001). Primary fistulas accounted for 42% and secondary fistulas for 58%. Of patients who underwent surgical intervention for chronic Q fever-related fistula (n = 17), nine died of chronic Q fever-related causes (53%). Of patients who did not undergo any surgical intervention (n = 8), six died of chronic Q fever-related causes (75%). CONCLUSIONS: The proportion of patients with proven chronic Q fever developing primary or secondary arterial fistulas is high; 15% of patients with a vascular focus of infection develop an arterial fistula. This observation suggests that C. burnetii, the causative agent of Q fever, plays a role in the development of fistulas in these patients. Chronic Q fever-related mortality in patients with arterial fistula is very high, in both patients who undergo surgical intervention and patients who do not.
Asunto(s)
Aneurisma Infectado/microbiología , Fístula Arteriovenosa/microbiología , Fístula Bronquial/microbiología , Fístula Bronquial/cirugía , Fístula Cutánea/microbiología , Endocarditis Bacteriana/microbiología , Fístula Intestinal/microbiología , Infecciones Relacionadas con Prótesis/microbiología , Fiebre Q/microbiología , Anciano , Anciano de 80 o más Años , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/mortalidad , Aneurisma Infectado/cirugía , Fístula Arteriovenosa/diagnóstico , Fístula Arteriovenosa/mortalidad , Fístula Arteriovenosa/cirugía , Fístula Bronquial/diagnóstico , Fístula Bronquial/mortalidad , Fístula Cutánea/diagnóstico , Fístula Cutánea/mortalidad , Fístula Cutánea/cirugía , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/mortalidad , Endocarditis Bacteriana/cirugía , Femenino , Humanos , Incidencia , Fístula Intestinal/diagnóstico , Fístula Intestinal/mortalidad , Fístula Intestinal/cirugía , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Pronóstico , Infecciones Relacionadas con Prótesis/diagnóstico , Infecciones Relacionadas con Prótesis/mortalidad , Infecciones Relacionadas con Prótesis/cirugía , Fiebre Q/diagnóstico , Fiebre Q/mortalidad , Fiebre Q/cirugía , Sistema de Registros , Estudios Retrospectivos , Factores de Riesgo , Factores de TiempoRESUMEN
Herein, we describe the first case of mammary implant infection caused by Coxiella burnetii, resulting in delayed diagnosis and treatment and an in-hospital cross-transmission of Q fever to medical personnel.
Asunto(s)
Implantes de Mama/efectos adversos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Infecciones Relacionadas con Prótesis/microbiología , Fiebre Q/transmisión , Adulto , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Antimaláricos/administración & dosificación , Antimaláricos/uso terapéutico , Azitromicina/administración & dosificación , Azitromicina/uso terapéutico , Coxiella burnetii/aislamiento & purificación , Femenino , Hospitales , Humanos , Masculino , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Infecciones Relacionadas con Prótesis/cirugía , Fiebre Q/tratamiento farmacológico , Fiebre Q/cirugía , Adulto JovenAsunto(s)
Aneurisma de la Aorta Torácica/cirugía , Implantación de Prótesis Vascular/métodos , Procedimientos Endovasculares/métodos , Infecciones Relacionadas con Prótesis/cirugía , Fiebre Q/cirugía , Stents/efectos adversos , Anciano , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Angiografía por Tomografía Computarizada , Femenino , Humanos , Infecciones Relacionadas con Prótesis/microbiología , Fiebre Q/microbiología , Stents/microbiologíaRESUMEN
We conducted this study to determine the risk of transmission of Q fever to health care workers (HCWs) during perioperative exposure to Coxiella burnetii-infected thoracic endovascular aneurysm stent graft. Pre-operative and 6-week post-operative phase I and II IgG Q fever antibody titers were determined in 14 staff members of an operation room. The room had a negative pressure and all the members of the surgical team wore either a fitted N-95 mask or a powered purified air respirator. Phase I and II IgG antibody titers were <1:16 for 11 of the 14 studied HCWs; 2 HCWs did not follow up at 6 weeks and 1 had a pre-exposure phase II IgG titer of 1:128 with no change 6 weeks later. We concluded that risk of transmission of C. burnetii in the operating room from infected patient to HCWs who wore appropriate personal protective equipment is low.
Asunto(s)
Coxiella burnetii/aislamiento & purificación , Cuerpo Médico de Hospitales , Exposición Profesional , Periodo Perioperatorio , Fiebre Q/transmisión , Stents/microbiología , Aneurisma/cirugía , Humanos , Fiebre Q/cirugía , TexasRESUMEN
Q fever is a worldwide zoonosis caused by an intracellular bacillus named Coxiella burnetii (CB) and is a rare cause of vascular infections. We report a case of abdominal aortic aneurysm infected by CB with bilateral paravertebral abscesses and contiguous spondylodiscitis treated by open repair using a cryopreserved allograft and long-term antibiotic therapy by oral doxycycline and oral hydroxychloroquine for a duration of 18 months. Twenty months after the operation, the patient had no infections signs and vascular complication.
Asunto(s)
Aneurisma Infectado/cirugía , Aneurisma de la Aorta Abdominal/cirugía , Bioprótesis , Implantación de Prótesis Vascular/instrumentación , Prótesis Vascular , Coxiella burnetii/aislamiento & purificación , Criopreservación , Fiebre Q/cirugía , Administración Oral , Anciano de 80 o más Años , Aloinjertos , Aneurisma Infectado/diagnóstico por imagen , Aneurisma Infectado/microbiología , Aneurisma Infectado/transmisión , Antibacterianos/administración & dosificación , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/microbiología , Aortografía/métodos , Doxiciclina/administración & dosificación , Esquema de Medicación , Humanos , Hidroxicloroquina/administración & dosificación , Imagen por Resonancia Magnética , Masculino , Fiebre Q/diagnóstico por imagen , Fiebre Q/microbiología , Fiebre Q/transmisión , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Coxiella burnetii vascular infections continue to be very severe diseases and no guidelines exist about their prevention. In terms of treatment, the benefit of the surgical removal of infected tissues has been suggested by 1 retrospective study.We present a case of a C burnetii abdominal aortic graft infection for which we observed a dramatic clinical and biological recovery after surgery. We thus performed a retrospective cohort study to evaluate the impact of surgery on survival and serological outcome for patients with Q fever vascular infections diagnosed in our center.Between 1986 and February 2015, 100 patients were diagnosed with Q fever vascular infections. The incidence of these infections has significantly increased over the past 5 years, in comparison with the mean annual incidence over the preceding 22 years (8.83 cases per year versus 3.14 cases per year, Pâ=â0.001). A two-and-a-half-year follow-up was available for 66 patients, of whom 18.2% died. We observed 6.5% of deaths in the group of patients who were operated upon at 2 and a half years, in comparison with 28.6% in the group which were not operated upon (Pâ=â0.02). Surgery was the only factor that had a positive impact on survival at 2 and a half years using univariate analysis [hazard ratio: 0.17 [95% CI]: [0.039-0.79]; Pâ=â0.024]. Surgery was also associated with a good serological outcome (74.1% vs 57.1% of patients, Pâ=â0.03). In the group of patients with vascular graft infections (nâ=â47), surgery had a positive impact on serological outcome at 2 and a half years (85.7% vs 42.9%, Pâ<â0.001) [hazard ratio: 0.40 [95% CI]: [0.17-098]; Pâ=â0.046] and tended to be associated with lower although not statistically significant mortality (11.1% vs 27.6% of deaths, Pâ=â0.19).Surgical treatment confers a benefit in terms of survival following C burnetii vascular infections. However, given the high mortality of these infections and their rising incidence, we propose a strategy that consists of screening for vascular graft and aneurysms in the context of primary Q fever, to decide when to start prophylactic treatment, similar to the strategy recommended for the prophylaxis of Q fever endocarditis.
Asunto(s)
Aneurisma de la Aorta Abdominal/microbiología , Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Torácica/microbiología , Aneurisma de la Aorta Torácica/cirugía , Rotura de la Aorta/microbiología , Rotura de la Aorta/cirugía , Implantación de Prótesis Vascular , Prótesis Vascular/microbiología , Fiebre Q/prevención & control , Fiebre Q/cirugía , Infección de la Herida Quirúrgica/microbiología , Infección de la Herida Quirúrgica/cirugía , Adulto , Aneurisma de la Aorta Abdominal/mortalidad , Aneurisma de la Aorta Torácica/mortalidad , Rotura de la Aorta/mortalidad , Estudios de Cohortes , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/prevención & control , Fluorodesoxiglucosa F18 , Estudios de Seguimiento , Humanos , Masculino , Imagen Multimodal , Tomografía de Emisión de Positrones , Fiebre Q/mortalidad , Estudios Retrospectivos , Infección de la Herida Quirúrgica/mortalidad , Tasa de Supervivencia , Tomografía Computarizada por Rayos XRESUMEN
Q fever osteomyelitis, caused by infection with Coxiella burnetti, is rare but should be included in the differential diagnosis of children with culture-negative osteomyelitis, particularly if there is a history of contact with farm animals, and/or granulomatous change on histologic examination of a bone biopsy specimen. We describe a case of Q fever osteomyelitis in a 6-year-old boy in which a decision was made not to treat the patient with combination antimicrobial agents, balancing possible risks of recurrence against potential side effects of prolonged antibiotic treatment. The patient had undergone surgical debridement of a single lesion and was completely asymptomatic after recovery from surgery. This case suggests that a conservative approach of watchful waiting in an asymptomatic patient with chronic Q fever osteomyelitis may be warranted in select cases when close follow-up is possible.
Asunto(s)
Desbridamiento , Osteomielitis/cirugía , Fiebre Q/cirugía , Espera Vigilante , Antibacterianos/uso terapéutico , Niño , Humanos , Masculino , Osteomielitis/diagnóstico , Osteomielitis/microbiología , Fiebre Q/diagnósticoRESUMEN
OBJECTIVE: Since chronic Q fever often develops insidiously, and symptoms are not always recognized at an early stage, complications are often present at the time of diagnosis. We describe complications associated with vascular chronic Q fever as found in the largest cohort of chronic Q fever patients so far. METHODS: Patients with proven or probable chronic Q fever with a focus of infection in an aortic aneurysm or vascular graft were included in this study, using the Dutch national chronic Q fever database. RESULTS: A total of 122 patients were diagnosed with vascular chronic Q fever between April 2008 and June 2012. The infection affected a vascular graft in 62 patients (50.8%) and an aneurysm in 53 patients (43.7%). Seven patients (5.7%) had a different vascular focus. Thirty-six patients (29.5%) presented with acute complications, and 35 of these patients (97.2%) underwent surgery. Following diagnosis and start of antibiotic treatment, 26 patients (21.3%) presented with a variety of complications requiring surgical treatment during a mean follow-up of 14.1 ± 9.1 months. The overall mortality rate was 23.7%. Among these patients, mortality was associated with chronic Q fever in 18 patients (62.1%). CONCLUSIONS: The management of vascular infections with C. burnetii tends to be complicated. Diagnosis is often difficult due to asymptomatic presentation. Patients undergo challenging surgical corrections and long-term antibiotic treatment. Complication rates and mortality are high in this patient cohort.
Asunto(s)
Aneurisma Infectado/cirugía , Aneurisma de la Aorta/cirugía , Prótesis Vascular/efectos adversos , Brotes de Enfermedades , Infecciones Relacionadas con Prótesis/cirugía , Fiebre Q/cirugía , Procedimientos Quirúrgicos Vasculares , Anciano , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/microbiología , Aneurisma Infectado/mortalidad , Antibacterianos/uso terapéutico , Aneurisma de la Aorta/diagnóstico , Aneurisma de la Aorta/microbiología , Aneurisma de la Aorta/mortalidad , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Valor Predictivo de las Pruebas , Infecciones Relacionadas con Prótesis/diagnóstico , Infecciones Relacionadas con Prótesis/microbiología , Infecciones Relacionadas con Prótesis/mortalidad , Fiebre Q/diagnóstico , Fiebre Q/microbiología , Fiebre Q/mortalidad , Sistema de Registros , Reoperación , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares/efectos adversos , Procedimientos Quirúrgicos Vasculares/mortalidadRESUMEN
Q fever is a bacterial infection caused by Coxiella burnetti. It can cause both acute and chronic illness. Chronic QF can present as a variety of clinical syndromes. A common and critical manifestation is endocarditis which can present atypically and is easily missed. This case describes a man who, after extensive investigation for splenomegaly and pancytopenia by several specialties, was finally diagnosed with Q fever endocarditis after unexpected aortic valve abnormalities found during elective cardiac surgery. Several factors contributed to diagnostic delay including aspects of clinical assessment and radiologic findings. Vigilance is essential for diagnosis and prompt initiation of effective treatment.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Diagnóstico Tardío , Fiebre Q/diagnóstico , Fiebre Q/cirugía , Procedimientos Quirúrgicos Electivos , Humanos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: The objective of our study was to analyze the efficacy of autologous superficial femoropopliteal vein reconstruction for primary aortic or aortic graft infection. METHODS: We performed a retrospective analysis of 14 patients treated for an infected aortic prosthesis or primary infected aorta between 2012 and 2014. Three patients had a primary mycotic aneurysm caused by a Salmonella or Coxiella burnetti infection. Seven patients were treated previously for aortic aneurysms with a conventional Dacron vascular prosthesis and 4 with an endovascular prosthesis. All infected prostheses were explanted via median laparotomy with subsequent debridement of the aortic aneurysm wall. Aortic reconstruction was performed with 1 or 2 superficial femoropopliteal veins, interpositioning the greater omentum when possible. The primary outcome measure was 30-day mortality. Secondary outcome measures were reoperation, operating time, amputation rate, length of intensive care unit (ICU) and hospital stay, reinfection rate, and limb edema requiring compression therapy. RESULTS: The 30-day mortality was 28%. Two patients died of an abdominal sepsis, one patient of a cerebrovascular accident and another of a hypovolemic shock. One patient died at home 2 years after surgery of unknown cause. Four patients required a reoperation. The median intraoperative blood loss was 1,500 mL (500-8000). Median operating time was 364 min (264-524). Median length of ICU stay was 3.5 days (1-47), and median hospital stay was 20 days (10-47). There were no limb amputations. Mild edema of the donor leg was documented in 2 patients. Compression stockings were not worn by any patients. Postoperative antibiotic treatment was administered for at least 6 weeks. No recurrent infections were diagnosed. CONCLUSIONS: Autologous venous reconstruction of the aorta offers advantages over other therapeutic approaches and deserves a prominent place in the treatment of the primary infected aorta or an infected aortic prosthetic graft.
Asunto(s)
Aneurisma Infectado/cirugía , Aneurisma de la Aorta/cirugía , Prótesis Vascular/efectos adversos , Vena Femoral/trasplante , Procedimientos de Cirugía Plástica , Vena Poplítea/trasplante , Infecciones Relacionadas con Prótesis/cirugía , Fiebre Q/cirugía , Infecciones por Salmonella/cirugía , Anciano , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/microbiología , Aneurisma Infectado/mortalidad , Antibacterianos/uso terapéutico , Aneurisma de la Aorta/diagnóstico , Aneurisma de la Aorta/microbiología , Aneurisma de la Aorta/mortalidad , Aortografía/métodos , Autoinjertos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tomografía de Emisión de Positrones , Infecciones Relacionadas con Prótesis/diagnóstico , Infecciones Relacionadas con Prótesis/microbiología , Infecciones Relacionadas con Prótesis/mortalidad , Fiebre Q/diagnóstico , Fiebre Q/microbiología , Fiebre Q/mortalidad , Procedimientos de Cirugía Plástica/efectos adversos , Procedimientos de Cirugía Plástica/mortalidad , Reoperación , Estudios Retrospectivos , Factores de Riesgo , Infecciones por Salmonella/diagnóstico , Infecciones por Salmonella/microbiología , Infecciones por Salmonella/mortalidad , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del TratamientoAsunto(s)
Coxiella burnetii/aislamiento & purificación , Endocarditis/diagnóstico , Endocarditis/patología , Cardiopatías Congénitas/diagnóstico , Cardiopatías Congénitas/patología , Enfermedades de las Válvulas Cardíacas/diagnóstico , Enfermedades de las Válvulas Cardíacas/patología , Fiebre Q/diagnóstico , Fiebre Q/patología , Anciano , Válvula Aórtica/microbiología , Válvula Aórtica/patología , Válvula Aórtica/cirugía , Técnicas Bacteriológicas , Enfermedad de la Válvula Aórtica Bicúspide , Puente de Arteria Coronaria , Endocarditis/microbiología , Endocarditis/cirugía , Cardiopatías Congénitas/microbiología , Cardiopatías Congénitas/cirugía , Enfermedades de las Válvulas Cardíacas/microbiología , Enfermedades de las Válvulas Cardíacas/cirugía , Prótesis Valvulares Cardíacas , Humanos , Masculino , Microscopía , Reacción en Cadena de la Polimerasa , Fiebre Q/microbiología , Fiebre Q/cirugíaRESUMEN
Untreated chronic Q fever causes a high number of complications and deaths. We present cases of chronic Q fever that were not diagnosed until after the patients underwent cardiac valve surgery. In epidemic areas, Q fever screening of valve surgery patients secures early initiation of treatment and can prevent illness and death.
Asunto(s)
Coxiella burnetii/aislamiento & purificación , Endocarditis Bacteriana/diagnóstico , Prótesis Valvulares Cardíacas/microbiología , Fiebre Q/diagnóstico , Anciano , Anticuerpos Antibacterianos/sangre , Anticuerpos Antibacterianos/inmunología , Coxiella burnetii/inmunología , Diagnóstico Tardío , Endocarditis Bacteriana/complicaciones , Endocarditis Bacteriana/inmunología , Endocarditis Bacteriana/cirugía , Femenino , Válvulas Cardíacas/cirugía , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina G/inmunología , Masculino , Fiebre Q/complicaciones , Fiebre Q/inmunología , Fiebre Q/cirugíaRESUMEN
Coxiella burnetii is a rare cause of vascular infections. Yet, Q fever is endemic in the southern part of The Netherlands. This report describes two patients--from the southern part of The Netherlands--with infected aneurysms of the abdominal aorta caused by Coxiella burnetii. Both patients underwent surgical debridement, in situ reconstruction with a great saphenous vein spiral graft, and a transmesenteric omentumplasty. One patient fully recovered, while the other died due to ischemic complications. A multidisciplinary work-up approach to treat infected abdominal aneurysms is proposed, including adequate surgical treatment and long-term antibiotic administration.
Asunto(s)
Aneurisma Infectado/cirugía , Aneurisma de la Aorta Abdominal/cirugía , Coxiella burnetii/aislamiento & purificación , Procedimientos de Cirugía Plástica , Fiebre Q/cirugía , Vena Safena/trasplante , Anciano , Anciano de 80 o más Años , Aneurisma Infectado/diagnóstico por imagen , Aneurisma Infectado/microbiología , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/microbiología , Aortografía/métodos , Colon/irrigación sanguínea , Desbridamiento , Resultado Fatal , Humanos , Isquemia/etiología , Extremidad Inferior/irrigación sanguínea , Masculino , Fiebre Q/diagnóstico por imagen , Fiebre Q/microbiología , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Chronic Q fever infections, caused by Coxiella burnetii, are associated with cardiovascular complications, mainly endocarditis and vascular (graft) infections. We report a case of a patient with a C. burnetii infected thoracic aorta graft treated initially in a conservative way. However, surgical excision of the infected graft was eventually necessary. This case report highlights the challenges regarding the treatment of patients with chronic vascular C. burnetii infections. In the absence of practical guidelines, treatment is tailored to the individual patient. Furthermore, we want to emphasize the need to include chronic Q fever in the differential diagnosis in patients with culture negative aortitis, especially in the regions with Q fever epidemics in the recent past.
Asunto(s)
Aorta Torácica/cirugía , Implantación de Prótesis Vascular/métodos , Prótesis Vascular/efectos adversos , Infecciones Relacionadas con Prótesis/cirugía , Fiebre Q/cirugía , Prótesis Vascular/microbiología , Implantación de Prótesis Vascular/instrumentación , Enfermedad Crónica , Femenino , Humanos , Persona de Mediana Edad , Infecciones Relacionadas con Prótesis/diagnóstico , Fiebre Q/diagnóstico , ReoperaciónRESUMEN
BACKGROUND: Prosthetic valve endocarditis (PVE) is a serious complication of valve surgery. AIM: The aim of this study is to determine the diagnostic and therapeutic management for PVE. METHODS: It's a retrospective study about 14 cases of PVE operated in the department of cardiovascular surgery of la Rabta hospital between January 1996 and December 2006. RESULTS: In two cases, surgery was performed emergent, in the remnant cases surgery was elective. The coagulase-negative staphylococcus (CNS) is the predominant cause of these PVE.Surgery consisted on seven mitral prosthesis replacements and seven aortic prosthesis replacements.Hospital mortality was 50%. CONCLUSION: In conclusion attention should be made to prevent endocarditis when possible. In case of PVE, an early diagnosis a leads to earlier application of appropriate therapies and improved outcome.
Asunto(s)
Válvula Aórtica/microbiología , Endocarditis Bacteriana/microbiología , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Válvula Mitral/microbiología , Infecciones Relacionadas con Prótesis/microbiología , Fiebre Q/complicaciones , Infecciones Estafilocócicas/complicaciones , Adulto , Válvula Aórtica/patología , Válvula Aórtica/cirugía , Endocarditis Bacteriana/mortalidad , Endocarditis Bacteriana/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Válvula Mitral/patología , Válvula Mitral/cirugía , Falla de Prótesis , Infecciones Relacionadas con Prótesis/mortalidad , Infecciones Relacionadas con Prótesis/cirugía , Fiebre Q/mortalidad , Fiebre Q/cirugía , Reoperación , Estudios Retrospectivos , Infecciones Estafilocócicas/mortalidad , Infecciones Estafilocócicas/cirugíaAsunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular/efectos adversos , Prótesis Vascular/efectos adversos , Tomografía de Emisión de Positrones , Infecciones Relacionadas con Prótesis/diagnóstico , Fiebre Q/diagnóstico , Tomografía Computarizada por Rayos X , Antibacterianos/uso terapéutico , Enfermedad Crónica , Terapia Combinada , Remoción de Dispositivos , Fluorodesoxiglucosa F18 , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Infecciones Relacionadas con Prótesis/cirugía , Fiebre Q/tratamiento farmacológico , Fiebre Q/cirugía , Radiofármacos , Sensibilidad y Especificidad , Resultado del TratamientoRESUMEN
Coxiella Burnetii endocarditis is very rare. It is the main complication of the chronic form of Q fever. Blood cultures are negative and clinical presentation very variable and diagnosis is essentially based on indirect immunofluorescence serum analysis. The authors report the case of a 19 year old patient with a history of rheumatic aortic regurgitation admitted for an episode of left ventricular failure in a context of long-term pyrexia without valvular vegetations or mutilation. The antiphase I Ig G antibody levels were significant. Treatment with doxycycline and fluoroquinolone was initiated. The clinical improvement was spectacular. Three months later, the patient underwent aortic valve replacement and histological examination of the valve showed subacute endocarditis on chronically fibrotic valvular disease. This is an interesting case by its rarity and its diagnostic and therapeutic problems.