BACKGROUND: Immunoglobulin G (IgG) anticardiolipin (aCL) antibodies are associated with valvulopathy and endocarditis in patients with lupus and other diseases. During acute Q fever, high IgG aCL prevalence has been reported, but the clinical significance remains unknown. METHODS: To test if increased IgG aCL at acute Q fever diagnosis is associated with an increased risk of progression to endocarditis, all patients diagnosed in the French National Referral Center for Q fever from January 2007 to December 2011 were included and followed regularly until January 2013 in a 5-year prospective cohort study. Q fever endocarditis was defined according to recently updated criteria. RESULTS: Seventy-two patients were followed for a median time of 31 months (interquartile range, 18-47 months). Of these, 13 patients with valvulopathy without antibiotic prophylaxis progressed to endocarditis. IgG aCL levels were highly prevalent (57%) and significantly higher in the presence of a valvulopathy (P = .005). Using Cox regression analysis, highly increased levels of IgG aCL (adjusted hazard ratio [AHR], 12.95; 95% confidence interval, 2.85-58.95; P = .001) and high levels of phase II immunoglobulin M (IgM; AHR, 6.59; 95% CI, 1.37-31.62; P = .018) were the only independent predictors of progression to endocarditis. CONCLUSIONS: Rapid progression from acute Q fever to endocarditis is associated with high levels of IgG aCL and high levels of phase II IgM, findings that should be critical in the prevention of endocarditis.
BACKGROUND: Immunoglobulin G (IgG) anticardiolipin (aCL) antibodies are associated with valvulopathy and endocarditis in patients with lupus and other diseases. During acute Q fever, high IgG aCL prevalence has been reported, but the clinical significance remains unknown. METHODS: To test if increased IgG aCL at acute Q fever diagnosis is associated with an increased risk of progression to endocarditis, all patients diagnosed in the French National Referral Center for Q fever from January 2007 to December 2011 were included and followed regularly until January 2013 in a 5-year prospective cohort study. Q fever endocarditis was defined according to recently updated criteria. RESULTS: Seventy-two patients were followed for a median time of 31 months (interquartile range, 18-47 months). Of these, 13 patients with valvulopathy without antibiotic prophylaxis progressed to endocarditis. IgG aCL levels were highly prevalent (57%) and significantly higher in the presence of a valvulopathy (P = .005). Using Cox regression analysis, highly increased levels of IgG aCL (adjusted hazard ratio [AHR], 12.95; 95% confidence interval, 2.85-58.95; P = .001) and high levels of phase II immunoglobulin M (IgM; AHR, 6.59; 95% CI, 1.37-31.62; P = .018) were the only independent predictors of progression to endocarditis. CONCLUSIONS: Rapid progression from acute Q fever to endocarditis is associated with high levels of IgG aCL and high levels of phase II IgM, findings that should be critical in the prevention of endocarditis.
Authors: C Zaratzian; F Gouriet; H Tissot-Dupont; J-P Casalta; M Million; N Bardin; D Grisoli; G Habib; D Raoult Journal: Eur J Clin Microbiol Infect Dis Date: 2017-02-09 Impact factor: 3.267
Authors: Hang Jin Jeong; Sangho Choi; Jeongmin Lee; Byoungchul Gill; Kang Mo Lee; Yeong Seon Lee; Choon-Mee Kim; Na-Ra Yun; Dong-Min Kim Journal: Am J Trop Med Hyg Date: 2019-05 Impact factor: 2.345
Authors: Simon Bessis; Daniel Bertin; Matthieu Million; Line Meddeb; Michel Drancourt; Jean-Christophe Lagier; Jean-Louis Mège; Nathalie Bardin; Philippe Brouqui Journal: J Clin Tuberc Other Mycobact Dis Date: 2019-02-15