title: Coxiella burnetii infection in hemodialysis and other vascular grafts.
abstract: Prosthetic arteriovenous (AV) graft infection is the principal cause of morbidity related to chronic hemodialysis AV graft fistula. Coxiella burnetii is a known pathogen that causes fever, pneumonia, and intravascular infections with the limitation of negative cultures. Herein, we report the first case of a patient who presented to the emergency department of our hospital with a prosthetic hemodialysis AV graft infection due to Coxiella burnetii. We also performed a literature search with PubMed to identify studies reporting cases of Coxiella burnetii vascular graft infection. Overall, we reviewed 15 cases of vascular graft infection, including ours. We found a high prevalence of male patients (87%); mean age ± standard deviation (SD) of the entire population was 60.4 ± 9.6 years. The dacron infrarenal aortic and the aortobifemoral bypass were the most common involved grafts. The early diagnosis of infection due to Coxiella burnetii was done by serology or with polymerase chain reaction (PCR), in 12 and 3 cases, respectively. All patients underwent partial or complete resection of the infected grafts; the most common antibiotic treatment for this entity was doxycycline and hydroxycloroquine.Although this is a relatively rare disease, Coxiella burnetii should be included in the differential diagnosis of all patients who present with infection of an endovascular graft of any nature with an inconclusive etiologic diagnosis.
authors.affiliation: Department of Clinical Microbiology and Infectious Diseases (MGDV, AV, MV, MM, PM, EB), Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón; Department of Nephrology (EV), Hospital General Universitario Gregorio Marañón, Madrid; and Facultad de Medicina (MM, PM, EB), Universidad Complutense de Madrid (UCM), Spain.
authors.forename: Marcela
authors.initials: M
authors.lastname: González-Del Vecchio
authors.forename: Antonio
authors.initials: A
authors.lastname: Vena
authors.forename: Maricela
authors.initials: M
authors.lastname: Valerio
authors.forename: Mercedes
authors.initials: M
authors.lastname: Marin
authors.forename: Eduardo
authors.initials: E
authors.lastname: Verde
authors.forename: Patricia
authors.initials: P
authors.lastname: Muñóz
authors.forename: Emilio
authors.initials: E
authors.lastname: Bouza
mesh_terms: D001807:Blood Vessel Prosthesis / Q000009:adverse effects* / Q000382:microbiology; D016997:Coxiella burnetii; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011778:Q Fever / Q000175:diagnosis / Q000209:etiology*; D006435:Renal Dialysis / Q000009:adverse effects*