title: Myocarditis, a rare but severe manifestation of Q fever: report of 8 cases and review of the literature.
abstract: Myocarditis has only rarely been described as a manifestation of acute Q fever. Among our series of 1276 patients in whom acute Q fever was diagnosed during 1985--1999, myocarditis was diagnosed in 8. Two patients (25.0%) developed cardiac symptoms during the course of interstitial pneumonia, 2 (25.0%) initially presented with unexplained fever, and 1 (12.5%) presented with febrile cutaneous rash. In 3 patients, cardiac symptoms were inaugural: 1 patient experienced heart failure, and 2 experienced precordial pain. Dilated cardiomyopathy was documented in 7 patients, and 2 (1 of whom had undergone heart transplantation) died despite therapy. In addition, 1 patient was scheduled for heart transplantation because of cardiac insufficiency. When the patients in this study were compared with 32 control patients with acute Q fever, no specific epidemiological or clinical features were associated with this disease except worse prognosis (P=.006). Moreover, among the 12 patients from our series who died as a result of acute Q fever, 2 patients, who were significantly younger than the other 9 patients (P=.03), had myocarditis. Our study highlights the severity of Coxiella burnetii myocarditis.
authors.affiliation: Unité des Rickettsies, Centre National de Recherche Scientifique, Unité Mixte de Recherche 6020, Faculté de Médecine, Université de la Méditerranée, Marseille, France.
authors.forename: P E
authors.initials: PE
authors.lastname: Fournier
authors.forename: J
authors.initials: J
authors.lastname: Etienne
authors.forename: J R
authors.initials: JR
authors.lastname: Harle
authors.forename: G
authors.initials: G
authors.lastname: Habib
authors.forename: D
authors.initials: D
authors.lastname: Raoult
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000907:Antibodies, Bacterial / Q000097:blood; D016997:Coxiella burnetii / Q000276:immunology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000175:diagnosis / Q000382:microbiology*; D011778:Q Fever / Q000175:diagnosis
chemical_list: D000907:Antibodies, Bacterial