Department of Medical Microbiology, Laboratory for Pathology and Medical Microbiology (PAMM), de Run 6250, 5504 DL Veldhoven, The Netherlands.
Eur J Vasc Endovasc Surg. 2011 Sep;42(3):384-92. doi: 10.1016/j.ejvs.2011.04.013. Epub 2011 May 31.
Coxiella burnetii is a strict intracellular pathogen causing Q fever, a worldwide zoonosis with an extensive animal reservoir. Chronic Q fever infections are frequently associated with cardiovascular complications, mainly endocarditis, and also aortic aneurysms and vascular-graft infection. We present four cases of chronic Q fever infections and associated vascular complications, and review the literature to identify major symptoms and assess the prevalence, treatment and outcome in these challenging patients.
The demographic and clinical data of four patients presenting at our unit were analysed. PubMed was searched to identify articles describing patients with chronic Q-fever-associated vascular complications.
Combining our own with the published experience, 58 cases (49 male) of chronic Q-fever-associated vascular complications were identified. The average age of the patients was 64 years (range: 30-83 years). As many as 26 patients had vascular graft infections (25 Dacron/polytetrafluoroethylene (PTFE), one homograft) and 32 had infected aneurysms. The majority of these patients presented with fever (n = 40) and/or pain (n = 43). Weight loss and fatigue were seen in 25 and 14 patients, respectively. Aneurysm rupture, aorto-enteric fistulae and lower-limb embolisation were seen in nine, four and four patients, respectively. Concurrent endocarditis was seen in two patients, whereas, for 15 cases, this information was not available. Patients were treated with antibiotics for an average of 23 months (range 1-54 months). Treatment of infected vascular segments was described in 50 patients. Ten patients were treated conservatively whilst 40 underwent resection of the infected vessel and reconstruction with a graft. Major surgical complications (graft infection, n = 3;aorto-enteric fistula, n = 2; bleeding, n = 1; anastomotic leakage, n = 1; aortic dissection, n = 1; vertebral osteomyelitis, n = 3; graft thrombosis, n = 1; renal failure, n = 2; and pneumonia, n = 1) were reported in 11 cases (21%) and were not specified in 13. The overall mortality was 24% (14/58). Seven (18%) surgically treated patients died. Six of them died within 6 months of surgery and one patient at 3 years' follow-up. Seven out of 10 of the conservatively treated patients died within 3 years of diagnosis.
Aneurysms associated with Q-fever infections tend to be complicated, requiring challenging surgical corrections, and long-term antibiotic treatment. Major complications and mortality rates are significant, especially in conservatively treated patients.
柯克斯体是一种严格的细胞内病原体，可引起 Q 热，这是一种广泛存在于动物中的世界性人畜共患病。慢性 Q 热感染常与心血管并发症有关，主要是心内膜炎，也与主动脉瘤和血管移植物感染有关。我们报告了 4 例慢性 Q 热感染和相关的血管并发症，并回顾了文献，以确定这些具有挑战性的患者的主要症状以及患病率、治疗和预后。
分析了在我们单位就诊的 4 例患者的人口统计学和临床数据。通过 PubMed 检索描述慢性 Q 热相关血管并发症患者的文章。
结合我们自己的经验和已发表的经验，共发现 58 例（49 例男性）慢性 Q 热相关血管并发症患者。患者的平均年龄为 64 岁（范围：30-83 岁）。多达 26 例患者有血管移植物感染（25 例为涤纶/聚四氟乙烯（PTFE），1 例为同种异体移植物），32 例有感染性动脉瘤。这些患者大多数有发热（n=40）和/或疼痛（n=43）。25 例患者出现体重减轻，14 例患者出现疲劳。9 例患者分别出现动脉瘤破裂、主动脉肠瘘和下肢栓塞。2 例患者同时存在心内膜炎，而 15 例患者则无此信息。患者平均接受抗生素治疗 23 个月（范围 1-54 个月）。50 例患者接受了感染血管段的治疗。10 例患者接受保守治疗，40 例患者接受感染血管切除和移植物重建。11 例（21%）患者出现主要手术并发症（移植物感染，n=3；主动脉肠瘘，n=2；出血，n=1；吻合口漏，n=1；主动脉夹层，n=1；椎体骨髓炎，n=3；移植物血栓形成，n=1；肾衰竭，n=2；肺炎，n=1），13 例未具体说明。总死亡率为 24%（14/58）。7 例（18%）接受手术治疗的患者死亡。其中 6 例在手术后 6 个月内死亡，1 例在 3 年随访时死亡。10 例接受保守治疗的患者中，有 7 例在诊断后 3 年内死亡。
与 Q 热感染相关的动脉瘤往往较为复杂，需要进行具有挑战性的手术矫正，并需要长期的抗生素治疗。主要并发症和死亡率较高，尤其是在保守治疗的患者中。
