Matthieu Million1, Franck Thuny2, Nathalie Bardin3, Emmanouil Angelakis1, Sophie Edouard1, Simon Bessis1, Thomas Guimard4, Thierry Weitten5, François Martin-Barbaz6, Michèle Texereau6, Khelifa Ayouz7, Camelia Protopopescu8, Patrizia Carrieri8, Gilbert Habib9, Didier Raoult1. 1. Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Institut Hospitalier Universitaire Méditerranée-Infection, UM63, CNRS7278, IRD198, INSERM1095. 2. 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. 3. Laboratoire d'Immunologie, Aix-Marseille Université, Marseille. 4. Service d'Infectiologie, Centre Hospitalier Départemental-Vendée, La Roche-sur-Yon. 5. Service de médecine interne, Centre Hospitalier Intercommunal des Alpes du Sud, Gap. 6. Service de Maladies Infectieuses, Centre Hospitalier, Niort. 7. Service de Médecine Interne, Centre Hospitalier de Saumur. 8. INSERM, UMR912 (SESSTIM), IRD, Aix Marseille Université Observatoire régional de la santé Provence-Alpes-Côte d'Azur. 9. Service de Cardiologie, Hôpital de La Timone, Marseille, France.
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.
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: Moonsuk Bae; Hyo Joo Lee; Joung Ha Park; Seongman Bae; Jiwon Jung; Min Jae Kim; Sang-Oh Lee; Sang-Ho Choi; Yang Soo Kim; Yong Shin; Sung-Han Kim Journal: Ann Med Date: 2021-12 Impact factor: 4.709
Authors: Maria Bitsori; Eleni Vergadi; Ioannis Germanakis; Maria Raissaki; Emmanouil Galanakis Journal: Am J Trop Med Hyg Date: 2020-10 Impact factor: 3.707