title: Vascular complications and surgical interventions after world's largest Q fever outbreak.
abstract: OBJECTIVE
  Since chronic Q fever often develops insidiously, and symptoms are not always recognized at an early stage, complications are often present at the time of diagnosis. We describe complications associated with vascular chronic Q fever as found in the largest cohort of chronic Q fever patients so far.
  
  
  METHODS
  Patients with proven or probable chronic Q fever with a focus of infection in an aortic aneurysm or vascular graft were included in this study, using the Dutch national chronic Q fever database.
  
  
  RESULTS
  A total of 122 patients were diagnosed with vascular chronic Q fever between April 2008 and June 2012. The infection affected a vascular graft in 62 patients (50.8%) and an aneurysm in 53 patients (43.7%). Seven patients (5.7%) had a different vascular focus. Thirty-six patients (29.5%) presented with acute complications, and 35 of these patients (97.2%) underwent surgery. Following diagnosis and start of antibiotic treatment, 26 patients (21.3%) presented with a variety of complications requiring surgical treatment during a mean follow-up of 14.1 ± 9.1 months. The overall mortality rate was 23.7%. Among these patients, mortality was associated with chronic Q fever in 18 patients (62.1%).
  
  
  CONCLUSIONS
  The management of vascular infections with C. burnetii tends to be complicated. Diagnosis is often difficult due to asymptomatic presentation. Patients undergo challenging surgical corrections and long-term antibiotic treatment. Complication rates and mortality are high in this patient cohort.
authors.affiliation: Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands. Electronic address: pieter.broos@catharinaziekenhuis.nl.
authors.forename: Pieter P H L
authors.initials: PP
authors.lastname: Broos
authors.affiliation: Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.
authors.forename: Julia C J P
authors.initials: JC
authors.lastname: Hagenaars
authors.affiliation: Division of Medicine, Department of Internal Medicine and Infectious Diseases, University Medical Center, Utrecht, The Netherlands.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Kampschreur
authors.affiliation: Department of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Wever
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Chantal P
authors.initials: CP
authors.lastname: Bleeker-Rovers
authors.affiliation: Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.
authors.forename: Olivier H J
authors.initials: OH
authors.lastname: Koning
authors.affiliation: Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands.
authors.forename: Joep A W
authors.initials: JA
authors.lastname: Teijink
authors.affiliation: Department of Medical Microbiology, Laboratory for Pathology and Medical Microbiology (PAMM), Veldhoven, The Netherlands.
authors.forename: Marjolijn C A
authors.initials: MC
authors.lastname: Wegdam-Blans
mesh_terms: D000368:Aged; D000785:Aneurysm, Infected / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011237:Predictive Value of Tests; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D011778:Q Fever / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D012042:Registries; D012086:Reoperation; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality
chemical_list: D000900:Anti-Bacterial Agents