Long term vascular complications of Coxiella burnetii infection in Switzerland: cohort study.
OBJECTIVE
To evaluate the range of long term vascular manifestations of Coxiella burnetii infection.


METHODS
Cohort study in Switzerland of people affected in 1983 by the largest reported outbreak of Q fever and who were followed up 12 years later. Follow up information about possible vascular disease and endocarditis was obtained through a mailed questionnaire and death certificates.


METHODS
Val de Bagnes, a rural Alpine valley in Switzerland.


METHODS
2044 (87%) of 2355 people who had serum testing for Coxiella burnetii infection in 1983: 1247 were classed as not having been infected, 411 were classed as having been acutely infected, and 386 were classed as having been infected before 1983.


METHODS
Relative risk controlled for age and sex and 12 year risk of vascular diseases and endocarditis among infected participants as compared with those who had never been infected.


RESULTS
The 12 year risk of endocarditis or venous thromboembolic disease was not increased among those who had been acutely infected. The 12 year risk of arterial disease was significantly higher among those who had been acutely infected (7%) as compared with those who had never been infected (4%) (relative risk 2.2, 95% confidence interval 1.4 to 3.6). Specifically, there was an increased risk of developing a cerebrovascular accident (relative risk 3.7, 1.6 to 8.4) and cardiac ischaemia (relative risk 1.9, 1.04 to 3.4). 12 year mortality was significantly higher among the 411 people who had been acutely infected in 1983 (9.7%; age adjusted relative risk 1.8, 1.2 to 2.6) when compared with the 1247 participants who had remained serologically negative in 1983 (7.0%).


CONCLUSIONS
Coxiella burnetii infection may cause long term complications including vascular disease.
Lovey
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PY
Department of Internal Medicine, University Hospital of Geneva, Rue Micheli du Crest 24, 1211 Geneva 14, Switzerland. Pierre-Yves.Lovey@hcuge.ch
Morabia
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A
Bleed
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D
Péter
O
O
Dupuis
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G
Petite
J
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D000328:Adult; D015331:Cohort Studies; D016997:Coxiella burnetii; D005500:Follow-Up Studies; D006801:Humans; D011778:Q Fever / Q000150:complications* / Q000453:epidemiology; D012307:Risk Factors; D013557:Switzerland / Q000453:epidemiology; D014652:Vascular Diseases / Q000453:epidemiology / Q000382:microbiology*