title: Antiphospholipid Antibody Syndrome With Valvular Vegetations in Acute Q Fever.
abstract: BACKGROUND
  Coxiella burnetii endocarditis is considered to be a late complication of Q fever in patients with preexisting valvular heart disease (VHD). We observed a large transient aortic vegetation in a patient with acute Q fever and high levels of IgG anticardiolipin antibodies (IgG aCL). Therefore, we sought to determine how commonly acute Q fever could cause valvular vegetations associated with antiphospholipid antibody syndrome, which would be a new clinical entity.
  
  
  METHODS
  We performed a consecutive case series between January 2007 and April 2014 at the French National Referral Center for Q fever. Age, sex, history of VHD, immunosuppression, and IgG aCL assessed by enzyme-linked immunosorbent assay were tested as potential predictors.
  
  
  RESULTS
  Of the 759 patients with acute Q fever and available echocardiographic results, 9 (1.2%) were considered to have acute Q fever endocarditis, none of whom had a previously known VHD. After multiple adjustment, very high IgG aCL levels (>100 immunoglobulin G-type phospholipid units; relative risk [RR], 24.9 [95% confidence interval {CI}, 4.5-140.2]; P = .002) and immunosuppression (RR, 10.1 [95% CI, 3.0-32.4]; P = .002) were independently associated with acute Q fever endocarditis.
  
  
  CONCLUSIONS
  Antiphospholipid antibody syndrome with valvular vegetations in acute Q fever is a new clinical entity. This would suggest the value of systematically testing for C. burnetii in antiphospholipid-associated cardiac valve disease, and performing early echocardiography and antiphospholipid dosages in patients with acute Q fever.
authors.affiliation: Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Institut Hospitalier Universitaire Méditerranée-Infection, UM63, CNRS7278, IRD198, INSERM1095.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Million
authors.affiliation: Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Institut Hospitalier Universitaire Méditerranée-Infection, UM63, CNRS7278, IRD198, INSERM1095 Unité Nord Insuffisance cardiaque et Valvulopathies, Service de Cardiologie, Centre Hospitalier Universitaire de Marseille, Hôpital Nord.
authors.forename: Franck
authors.initials: F
authors.lastname: Thuny
authors.affiliation: Laboratoire d'Immunologie, Aix-Marseille Université, Marseille.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Bardin
authors.affiliation: Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Institut Hospitalier Universitaire Méditerranée-Infection, UM63, CNRS7278, IRD198, INSERM1095.
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Angelakis
authors.affiliation: Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Institut Hospitalier Universitaire Méditerranée-Infection, UM63, CNRS7278, IRD198, INSERM1095.
authors.forename: Sophie
authors.initials: S
authors.lastname: Edouard
authors.affiliation: Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Institut Hospitalier Universitaire Méditerranée-Infection, UM63, CNRS7278, IRD198, INSERM1095.
authors.forename: Simon
authors.initials: S
authors.lastname: Bessis
authors.affiliation: Service d'Infectiologie, Centre Hospitalier Départemental-Vendée, La Roche-sur-Yon.
authors.forename: Thomas
authors.initials: T
authors.lastname: Guimard
authors.affiliation: Service de médecine interne, Centre Hospitalier Intercommunal des Alpes du Sud, Gap.
authors.forename: Thierry
authors.initials: T
authors.lastname: Weitten
authors.affiliation: Service de Maladies Infectieuses, Centre Hospitalier, Niort.
authors.forename: François
authors.initials: F
authors.lastname: Martin-Barbaz
authors.affiliation: Service de Maladies Infectieuses, Centre Hospitalier, Niort.
authors.forename: Michèle
authors.initials: M
authors.lastname: Texereau
authors.affiliation: Service de Médecine Interne, Centre Hospitalier de Saumur.
authors.forename: Khelifa
authors.initials: K
authors.lastname: Ayouz
authors.affiliation: INSERM, UMR912 (SESSTIM), IRD, Aix Marseille Université Observatoire régional de la santé Provence-Alpes-Côte d'Azur.
authors.forename: Camelia
authors.initials: C
authors.lastname: Protopopescu
authors.affiliation: INSERM, UMR912 (SESSTIM), IRD, Aix Marseille Université Observatoire régional de la santé Provence-Alpes-Côte d'Azur.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Carrieri
authors.affiliation: Service de Cardiologie, Hôpital de La Timone, Marseille, France.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Habib
authors.affiliation: Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Institut Hospitalier Universitaire Méditerranée-Infection, UM63, CNRS7278, IRD198, INSERM1095.
authors.forename: Didier
authors.initials: D
authors.lastname: Raoult
mesh_terms: D017153:Antibodies, Anticardiolipin / Q000097:blood; D016736:Antiphospholipid Syndrome / Q000209:etiology* / Q000276:immunology; D016997:Coxiella burnetii; D004697:Endocarditis, Bacterial / Q000209:etiology* / Q000276:immunology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000209:etiology* / Q000276:immunology / Q000382:microbiology / Q000473:pathology; D006351:Heart Valves / Q000473:pathology; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000382:microbiology; D011778:Q Fever / Q000150:complications* / Q000276:immunology; D016896:Treatment Outcome
chemical_list: D017153:Antibodies, Anticardiolipin; D007074:Immunoglobulin G
keywords: Coxiella burnetii; Q fever; antiphospholipid antibodies; valvular heart disease