Lev B I, Shachar A, Segev S, Weiss P, Rubinstein E
Department of Medicine, Chaim Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel-Hashomer, Israel.
Arch Intern Med. 1988 Jul;148(7):1531-2.
Q fever endocarditis occurs in up to 11% of patients infected by Coxiella burnetti. Major clues for the diagnosis are culture-negative endocarditis, hepatic involvement, rash, and thrombocytopenia. Characteristically, the diagnosis is delayed. In our patient, Q fever endocarditis occurred without previously recorded signs of infection. Fever, rash, and hepatic involvement all occurred following aortic valve replacement. The histologic picture of the excised valve was consistent with endocarditis, and serologic tests disclosed elevated IgA and IgG antiphase 1 antibody titers against C burnetti, compatible with Q fever endocarditis. It is assumed that the exacerbation of quiescent Q fever endocarditis was caused by cardiac surgery and steroid therapy.
Q热心内膜炎发生在高达11%的被伯氏考克斯体感染的患者中。诊断的主要线索是血培养阴性的心内膜炎、肝脏受累、皮疹和血小板减少。其特点是诊断延迟。在我们的患者中，Q热心内膜炎发生时没有先前记录的感染迹象。发热、皮疹和肝脏受累均在主动脉瓣置换术后出现。切除瓣膜的组织学表现与心内膜炎一致，血清学检测显示针对伯氏考克斯体的IgA和IgG抗1期抗体滴度升高，符合Q热心内膜炎。据推测，静止性Q热心内膜炎的加重是由心脏手术和类固醇治疗引起的。
