title: Coxiella burnetii Endocarditis and Aortic Vascular Graft Infection: An Underrecognized Disease.
abstract: BACKGROUND
  Q fever is considered endemic worldwide, and endocarditis, or aortic vascular infection, or both caused by Coxiella burnetii can be a fatal disease. The importance of surgical intervention has not yet been defined. We performed a descriptive retrospective study to assess indications for surgical treatment, timing of treatment, and outcome.
  
  
  METHODS
  We studied all patients from the cardiac surgery department of a large tertiary hospital who underwent valve surgical procedure due to endocarditis or aortic surgical procedure due to graft infection.
  
  
  RESULTS
  Throughout a 10-year period, we performed a total of 171 procedures due to valve endocarditis and/or vascular infection. In 16 patients (9.36%) Coxiella burnetii infection was diagnosed. Ten patients had previous cardiac surgical procedures, 3 had previous aortic surgical procedures, 2 had preexisting valvular disease, and 1 patient had no previous valve disorder. All patients received prolonged oral-specific antibiotic therapy under serologic guidance. In 9 patients antibiotic treatment (doxycycline and hydroxychloroquine) was started before the surgical procedure (12.4 ± 37.5 days), and in 7 patients after the surgical procedure (5.1 ± 13.5 days). We observed one in-hospital death (6.25%) and no long-term mortality. The mean follow-up period was 50.5 ± 34.7 months (range, 2 to 104 months).
  
  
  CONCLUSIONS
  In this series surgical treatment yielded good results for both Q fever endocarditis and vascular graft infection. No association was found between timing of the surgical procedure and patients' outcomes.
authors.affiliation: Infectious Disease Unit, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Maor
authors.affiliation: Department of Cardiac Surgery, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Leonid
authors.initials: L
authors.lastname: Sternik
authors.affiliation: Department of Cardiac Surgery, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Boris
authors.initials: B
authors.lastname: Orlov
authors.affiliation: Infectious Disease Unit, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Galia
authors.initials: G
authors.lastname: Rahav
authors.affiliation: Infectious Disease Unit, Sheba Medical Center, Tel Hashomer, Israel; Department of the Management of the Health Sciences, Ariel University, Ariel, Israel.
authors.forename: Nathan
authors.initials: N
authors.lastname: Keller
authors.affiliation: Department of Cardiac Surgery, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Ehud
authors.initials: E
authors.lastname: Raanani
authors.affiliation: Department of Cardiac Surgery, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: alexanderkogan140@hotmail.com.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kogan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D016997:Coxiella burnetii / Q000302:isolation & purification*; D003951:Diagnostic Errors; D004452:Echocardiography; D004697:Endocarditis, Bacterial / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D011778:Q Fever / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents