Servicios de Cardiología, Hospital Universitario Virgen del Rocío, Sevilla.
Enferm Infecc Microbiol Clin. 2011 Feb;29(2):109-16. doi: 10.1016/j.eimc.2010.07.015. Epub 2011 Feb 17.
To describe the clinical presentation of a large number of Q fever endocarditis (QFE) and its management considering the role of serology.
Eighty-three patients with definite QFE (56 native and 27 prosthetic valve) with a long-term follow-up after stopping treatment (median: 48 months) were included. Final outcome (cure or relapse) was compared according with the serological titre at the end of therapy: less than 1:400 of phase I Ig G antibodies by indirect immunofluorescence (group 1, N=23) or more than 1:400 (group 2, N=30).
Eleven patients (13.2%) died from QFE and other 8 died for other reasons not related to endocarditis during follow-up. Surgery was performed in 61 (73.5%) patients and combined antimicrobial treatment was long (median: 23 months, IQR: 12 - 36). Seven relapses were observed, but five of them had received an initial incomplete antibiotic regimen. In patients who completed the programmed treatment (range: 12 - 89 months), serological titres at the end of therapy were not useful for predicting the final outcome: one relapse in each group.
QFE requires a prolonged antimicrobial treatment, but serological titres are not useful for determining its duration.
描述大量 Q 热心内膜炎（QFE）的临床特征，并考虑血清学的作用，描述其治疗管理方法。
纳入了 83 例经治疗停止后（中位时间：48 个月）进行了长期随访的明确 QFE 患者（56 例为原生瓣膜，27 例为人工瓣膜）。根据治疗结束时的血清学滴度，将最终结局（治愈或复发）进行比较：间接免疫荧光法检测一期 IgG 抗体滴度<1:400（组 1，N=23）或>1:400（组 2，N=30）。
11 例（13.2%）患者死于 QFE，另外 8 例患者在随访期间死于与心内膜炎无关的其他原因。61 例（73.5%）患者接受了手术，联合抗菌治疗时间较长（中位数：23 个月，IQR：12-36）。观察到 7 例复发，但其中 5 例接受了初始不完全抗生素治疗方案。在完成既定治疗方案（范围：12-89 个月）的患者中，治疗结束时的血清学滴度对预测最终结局没有帮助：每组各有 1 例复发。
QFE 需要长期的抗菌治疗，但血清学滴度对确定其持续时间没有帮助。
