title: Chronic Q fever: A missed prosthetic valve endocarditis possibly for years.
abstract: ChronicCoxiella burnetiiendocarditis usually develops in people with underlying heart disease and accounts for 60-70% of chronic Q fever. Onset is generally insidious and manifestations are atypical. The authors report a case ofCoxiella burnetiiprosthetic valve endocarditis in a 53 years- old patient with recurrent mechanical valve dehiscence on mitral position. He lived in a rural area with sheep and goats on the surroundings. During a 9 year- period, he was submitted to three cardiac mitral valve surgeries two of which with no Q fever diagnosis suspicion. Diagnosis was based on a positive serology test (Indirect imunofluorescence). Treatment consisted in a combination of prolonged course of hydroxychloroquine plus doxycycline and surgical replacement of the mitral valve, with a favorable outcome. With this case report, the authors pretend to highlight the not always expected diagnosis of Q fever endocarditis. If not considered, Coxiella burnetii endocarditis may lead to multiple cardiac surgeries, greater morbidity and potentially death.
authors.affiliation: Infectious Diseases Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, Instituto de Inovação e Investigação em Saúde (I3S), Grupo de I&D em Nefrologia e Doenças Infeciosas, Instituto Nacional de Engenharia Biomédica (INEB), Porto, Portugal.
authors.forename: Rita Veiga
authors.initials: RV
authors.lastname: Ferraz
authors.affiliation: Cardiothoracic Surgery Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, Portugal.
authors.forename: Marta
authors.initials: M
authors.lastname: Andrade
authors.affiliation: Internal Medicine Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, Porto, Portugal.
authors.forename: Filipa
authors.initials: F
authors.lastname: Silva
authors.affiliation: Infectious Diseases Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, Instituto de Inovação e Investigação em Saúde (I3S), Grupo de I&D em Nefrologia e Doenças Infeciosas, Instituto Nacional de Engenharia Biomédica (INEB), Porto, Portugal.
authors.forename: Paulo
authors.initials: P
authors.lastname: Andrade
authors.affiliation: Infectious Diseases Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, Instituto de Inovação e Investigação em Saúde (I3S), Grupo de I&D em Nefrologia e Doenças Infeciosas, Instituto Nacional de Engenharia Biomédica (INEB), Porto, Portugal.
authors.forename: Cláudia
authors.initials: C
authors.lastname: Carvalho
authors.affiliation: Cardiothoracic Surgery Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, Portugal.
authors.forename: José Pinheiro
authors.initials: JP
authors.lastname: Torres
authors.affiliation: Cardiothoracic Surgery Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, Portugal.
authors.forename: Jorge
authors.initials: J
authors.lastname: Almeida
authors.affiliation: Infectious Diseases Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, Instituto de Inovação e Investigação em Saúde (I3S), Grupo de I&D em Nefrologia e Doenças Infeciosas, Instituto Nacional de Engenharia Biomédica (INEB), Porto, Portugal.
authors.forename: António
authors.initials: A
authors.lastname: Sarmento
authors.affiliation: Infectious Diseases Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, Instituto de Inovação e Investigação em Saúde (I3S), Grupo de I&D em Nefrologia e Doenças Infeciosas, Instituto Nacional de Engenharia Biomédica (INEB), Porto, Portugal.
authors.forename: Lurdes
authors.initials: L
authors.lastname: Santos
keywords: Chronic Q fever; Coxiella burnetii; Endocarditis; Prosthetic valve