Department of Cardiology, Fiona Stanley Hospital, Perth, WA, Australia.
Department of Cardiothoracic Surgery, Fiona Stanley Hospital, Perth, WA, Australia.
Heart Lung Circ. 2021 Oct;30(10):1509-1515. doi: 10.1016/j.hlc.2021.04.022. Epub 2021 May 27.
Q fever endocarditis by Coxiella burnetii is rare and presents a diagnostic challenge. With limited data available, the aim of this study was to review all reported cases together with unpublished local cases to understand risk factor profiles, diagnostic methods, clinical features, treatments and outcomes.
A search of the PubMed database using the term 'Q fever endocarditis' identified cases between 1950-2019. Included cases had positive polymerase chain reaction testing, valve culture or serology. Separately, to identify local cases meeting our criteria we queried the Western Australian Health Open Patient Administration System at two local hospitals for the ICD-10-AM diagnosis code A78 between 2013-2019.
We identified 181 cases from 31 publications and four local cases to create a combined series of 185 cases. The majority 141 (76%) were male and only 11% had normal cardiac valves. Most (72%) of patients had a history of contact with animals or travel. Nearly all (98%) cases had positive serology and over half (56%) had surgery performed. Overall mortality was 17%, and mortality for native valve endocarditis and prosthetic valve endocarditis was 12% and 3% respectively. No patients treated with doxycycline and hydroxychloroquine died. Mortality prior to 1999 was 28%, compared with 5% for more recent cases.
Serological diagnosis is key in Q fever endocarditis and possible risk factors exist such as male gender, pre-existing valvular conditions and contact with animals or travel. Native valve endocarditis and treatment with drugs other than doxycycline and hydroxychloroquine increase the risk of death.
由贝氏柯克斯体引起的 Q 热心内膜炎很少见，且具有诊断挑战性。由于可用数据有限，本研究旨在回顾所有已报道病例及未发表的本地病例，以了解其危险因素概况、诊断方法、临床特征、治疗方法和结局。
通过在 PubMed 数据库中使用“Q 热心内膜炎”一词进行搜索，确定了 1950 年至 2019 年间的病例。纳入病例的聚合酶链反应检测、瓣膜培养或血清学检查均为阳性。另外，为了确定符合我们标准的本地病例，我们在两家当地医院的西澳大利亚州卫生开放患者管理系统中查询了 2013 年至 2019 年间 ICD-10-AM 诊断代码 A78。
我们从 31 篇文献和 4 例本地病例中确定了 181 例病例，创建了一个包含 185 例病例的综合系列。大多数患者（141 例，76%）为男性，仅有 11%的患者心脏瓣膜正常。大多数（72%）患者有接触动物或旅行的病史。几乎所有（98%）病例的血清学检查均为阳性，超过一半（56%）的患者接受了手术。总体死亡率为 17%，原发性心内膜炎和人工瓣膜心内膜炎的死亡率分别为 12%和 3%。未接受多西环素和羟氯喹治疗的患者均未死亡。1999 年之前的死亡率为 28%，而最近病例的死亡率为 5%。
血清学诊断是 Q 热心内膜炎的关键，存在一些可能的危险因素，如男性、原有瓣膜疾病以及接触动物或旅行。原发性心内膜炎和使用多西环素和羟氯喹以外的药物治疗会增加死亡风险。
