El Kouache M, Marmade L, Laaroussi M, Tribak M, Moughil S, Benomar M H, Kabbaj H, Abdelali S, Benomar A, Benomar M
Service de chirurgie cardio-vasculaire B, hôpital Avicenne, Rabat, Maroc.
Arch Mal Coeur Vaiss. 2005 Oct;98(10):1036-9.
Coxiella Burnetii endocarditis is very rare. It is the main complication of the chronic form of Q fever. Blood cultures are negative and clinical presentation very variable and diagnosis is essentially based on indirect immunofluorescence serum analysis. The authors report the case of a 19 year old patient with a history of rheumatic aortic regurgitation admitted for an episode of left ventricular failure in a context of long-term pyrexia without valvular vegetations or mutilation. The antiphase I Ig G antibody levels were significant. Treatment with doxycycline and fluoroquinolone was initiated. The clinical improvement was spectacular. Three months later, the patient underwent aortic valve replacement and histological examination of the valve showed subacute endocarditis on chronically fibrotic valvular disease. This is an interesting case by its rarity and its diagnostic and therapeutic problems.
伯纳特立克次体心内膜炎非常罕见。它是慢性Q热的主要并发症。血培养结果为阴性，临床表现差异很大，诊断主要基于间接免疫荧光血清分析。作者报告了一名19岁患者的病例，该患者有风湿性主动脉瓣关闭不全病史，因长期发热伴左心室衰竭发作入院，无瓣膜赘生物或毁损。I期抗Ig G抗体水平显著。开始使用强力霉素和氟喹诺酮进行治疗。临床改善非常显著。三个月后，患者接受了主动脉瓣置换术，瓣膜组织学检查显示慢性纤维化瓣膜病合并亚急性心内膜炎。该病例因其罕见性及其诊断和治疗问题而颇具意义。
