Risks factors and prevention of Q fever endocarditis.
Coxiella burnetii causes acute and chronic Q fever. To evaluate the risk factors of development of chronic endocarditis following Q fever and to assess the best preventive therapy, a retrospective study of patients diagnosed as having Q fever during 1985-2000 was conducted. Twelve patients with acute Q fever who developed endocarditis and 102 patients with Q fever endocarditis were included in the study. When compared to 200 control patients with acute Q fever, preexisting valvular disease (P<10(-7)), especially a prosthetic valve (P=.01), were encountered more often among patients with endocarditis. Among patients with valvular defects, we estimate the risk of developing endocarditis to be 39%. A combination of doxycycline plus hydroxychloroquine was better at preventing the development of endocarditis than doxycycline alone (P=.009). Our results should encourage physicians to detect valvular lesions in patients with acute Q fever and to search for acute Q fever in patients with a valvulopathy and unexplained fever. A proper treatment for such patients and a scheduled follow-up should reduce the risk of developing endocarditis.
Fenollar
F
F
Unité des Rickettsies, Centre Nationale de Recherche Scientifique, Faculté de Médecine, Université de la Méditerranée, 27 Boulevard Jean Moulin, 13385 Marseille cedex 05, France.
Fournier
P E
PE
Carrieri
M P
MP
Habib
G
G
Messana
T
T
Raoult
D
D
D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use; D004318:Doxycycline / Q000627:therapeutic use; D004697:Endocarditis, Bacterial / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011778:Q Fever / Q000150:complications / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors
D000890:Anti-Infective Agents; D006886:Hydroxychloroquine; D004318:Doxycycline