S E van Roeden1, P C Wever2, L M Kampschreur3, P Gruteke4, W van der Hoek5, A I M Hoepelman6, C P Bleeker-Rovers7, J J Oosterheert6. 1. University Medical Centre Utrecht, Utrecht, the Netherlands. Electronic address: s.vanroeden@gmail.com. 2. Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands. 3. Medical Centre Leeuwarden, Leeuwarden, the Netherlands. 4. Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands. 5. National Institute for Public Health and the Environment, Bilthoven, the Netherlands. 6. University Medical Centre Utrecht, Utrecht, the Netherlands. 7. Radboud university medical center, Nijmegen, the Netherlands.
Abstract
OBJECTIVES: Chronic infection with Coxiella burnetii (chronic Q fever) can cause life-threatening conditions such as endocarditis, infected vascular prostheses, and infected arterial aneurysms. We aimed to assess prognosis of chronic Q fever patients in terms of complications and mortality. METHODS: A large cohort of chronic Q fever patients was assessed to describe complications, overall mortality and chronic Q fever-related mortality. Chronic Q fever-related mortality was expressed as a case fatality rate (number of chronic Q fever-related deaths/number of chronic Q fever patients). RESULTS: Complications occurred in 166 of 439 (38%) chronic Q fever patients: in 61% of proven (153/249), 15% of probable (11/74), and 2% of possible chronic Q fever patients (2/116). Most frequently observed complications were acute aneurysms (14%), heart failure (13%), and non-cardiac abscesses (10%). Overall mortality was 38% (94/249) for proven chronic Q fever patients (median follow-up 3.6 years) and 22% (16/74) for probable chronic Q fever patients (median follow-up 4.7 years). The case fatality rate was 25% for proven (63/249) chronic Q fever patients and 4% for probable (3/74) chronic Q fever patients. Overall survival was significantly lower in patients with complications, compared to those without complications (p <0.001). CONCLUSIONS: In chronic Q fever patients, complications occur frequently and contribute to the mortality rate. Patients with proven chronic Q fever have the highest risk of complications and chronic Q fever-related mortality. Prognosis for patients with possible chronic Q fever is favourable in terms of complications and mortality.
OBJECTIVES:Chronic infection with Coxiella burnetii (chronic Q fever) can cause life-threatening conditions such as endocarditis, infected vascular prostheses, and infected arterial aneurysms. We aimed to assess prognosis of chronic Q feverpatients in terms of complications and mortality. METHODS: A large cohort of chronic Q feverpatients was assessed to describe complications, overall mortality and chronic Q fever-related mortality. Chronic Q fever-related mortality was expressed as a case fatality rate (number of chronic Q fever-related deaths/number of chronic Q feverpatients). RESULTS: Complications occurred in 166 of 439 (38%) chronic Q feverpatients: in 61% of proven (153/249), 15% of probable (11/74), and 2% of possible chronic Q feverpatients (2/116). Most frequently observed complications were acute aneurysms (14%), heart failure (13%), and non-cardiac abscesses (10%). Overall mortality was 38% (94/249) for proven chronic Q feverpatients (median follow-up 3.6 years) and 22% (16/74) for probable chronic Q feverpatients (median follow-up 4.7 years). The case fatality rate was 25% for proven (63/249) chronic Q feverpatients and 4% for probable (3/74) chronic Q feverpatients. Overall survival was significantly lower in patients with complications, compared to those without complications (p <0.001). CONCLUSIONS: In chronic Q feverpatients, complications occur frequently and contribute to the mortality rate. Patients with proven chronic Q fever have the highest risk of complications and chronic Q fever-related mortality. Prognosis for patients with possible chronic Q fever is favourable in terms of complications and mortality.
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