Endocarditis is not a usual manifestation of acute Q fever. There is an ongoing debate about the need to screen patients for valvular diseases after acute Q fever. We present, for the first time, three patients with bacterial endocarditis from different aetiologies and a simultaneous diagnosis of acute Q fever. All were treated with prolonged antimicrobial treatment, and none of them developed a persistent Q infection. We suggest screening patients with endocarditis from other aetiologies to Q fever.
A 58-year-old healthy male was admitted to the internal medicine department due to weakness, fever, and night sweats for two months. On physical examination, a systolic heart murmur 3/6 was heard over the left sternal border. Abnormal laboratory findings included leukocytosis of 14,000 per microliter, hemoglobin of 9.9 gr/dL, and C-reactive protein (CRP) of 79 mg/L. Five sets of blood cultures were positive for
Clinical, bacteriological, serological, and echocardiographic characteristics of three patients with bacterial endocarditis.
Patient | Previous risk factors | Results of blood cultures | Pathological echocardiographic findings | Surgery | First serology for Q fever | Duration of prophylaxis | Follow-up serology for Q fever (6–12 months from diagnosis) | Follow-up serology for Q fever (3–6 months from end of therapy) |
---|---|---|---|---|---|---|---|---|
1 | None |
|
Severe aortic regurgitation and a large vegetation | Aortic valve replacement | IgM II-100 |
12 months | IgM II-negative |
NA |
|
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2 | Aortic valve replacement and aortic composite graft |
|
None | NA | IgM II-negative |
4 months (stopped due to side effects: hyperpigmentation of the gingiva and calves) | IgM II-negative |
IgM II-negative |
|
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3 | Mitral valve replacement |
|
None | NA | IgM II-negative |
12 months | IgM II-negative |
IgM II-negative |
Two similar patients were treated in our hospital. The first was a 72-year-old male with a prosthetic aortic valve, who was admitted due to one month of fever, weight loss, and weakness. He had splenomegaly and a purpuric rash in both legs, mild pancytopenia, and blood cultures that grew
Both of these patients had a 4-fold increase of phase II IgG that confirmed a diagnosis of acute Q fever, and they were treated with doxycycline and hydroxychloroquine for 4 and 12 months, respectively, and both had no clinical or laboratory signs of a persistent infection.
Diagnosis of acute Q fever is based on serology, and the infection is asymptomatic in half of the cases [
Our patients had risk factors for recurrent endocarditis and were offered a prolonged antimicrobial treatment to reduce the risk for a persistent infection [
The authors declare that they have no conflicts of interest.