Duroux-Vouilloz C, Praz G, Francioli P, Péter O
Institut Central des Hôpitaux Valaisans, Sion.
Schweiz Med Wochenschr. 1998 Apr 4;128(14):521-7.
The purpose of this study was to analyse the clinical and serological follow-up in 21 patients with Q fever endocarditis in Switzerland from 1981 to 1993.
Criteria for Q fever endocarditis were the following: Coxiella burnetii phase I IgG > 1 : 2560 and IgA > 1 : 20 by indirect immunofluorescence. Methods to confirm the diagnosis include immunohistochemical demonstration of C. burnetii by microscopy in valvular material (1 case) and inoculation of this material in experimental animals (10 cases). Information on clinical course of the disease, laboratory abnormalities and treatment were obtained by chart review and a questionnaire sent to physicians who requested the serological tests for Q fever.
The average age of the patients was 47 years (15 men and 6 women). 64% of patients had a history of environmental exposure to C. burnetii. The median time of symptomatology before diagnosis was 5 months (1-108). 19/21 patients had valvular lesions, and 2/21 vascular Dacron prosthesis. Most patients presented with fever (18/21), congestive cardiac failure (14/21), weight loss (12/21), anemia (6/19), or thrombocytopenia (6/19). All the patients required antibiotic treatment. Cardiac surgery was performed in 15/21 patients. For 10 patients the geometric mean serological follow-up included at least titers at time of diagnosis (IgG anti-phase I antibodies 1 : 27024, IgA anti-phase I antibodies 1 : 685), at the end of therapy (IgG anti-phase I antibodies 1 : 2941, IgA anti-phase I antibodies 1 : 153) and 6 months after the end of therapy (IgG anti-phase I antibodies 1 : 368, IgA anti-phase I antibodies 1 : 40). The fall in anti-phase I titers was significant. During the clinical and serological outcome (median of 60 months and 69 months respectively) there was no recurrence of endocarditis and antibody titers to C. burnetii phase I remained low. Two patients died during the observation period, one from lung cancer, while the cause of death in the other was unknown.
Serology is the key to Q fever diagnosis. The duration of treatment, and the values to be used to establish cure of endocarditis, are not clearly defined. During the clinical and serological outcome (median of 60 months and 69 months respectively) there was no recurrence of endocarditis and antibody titers to C. burnetii phase I remained low.
本研究的目的是分析1981年至1993年瑞士21例Q热心内膜炎患者的临床和血清学随访情况。
Q热心内膜炎的诊断标准如下：通过间接免疫荧光法检测，伯纳特柯克斯体I相IgG>1:2560且IgA>1:20。确诊方法包括通过显微镜在瓣膜组织中进行伯纳特柯克斯体的免疫组织化学检测（1例）以及将该组织接种于实验动物（10例）。通过查阅病历和向申请Q热血清学检测的医生发送问卷，获取疾病临床病程、实验室异常情况及治疗方面的信息。
患者的平均年龄为47岁（15名男性和6名女性）。64%的患者有伯纳特柯克斯体环境暴露史。诊断前症状出现的中位时间为5个月（1 - 108个月）。21例患者中有19例有瓣膜病变，21例中有2例有血管涤纶人工瓣膜。大多数患者表现为发热（21例中的18例）、充血性心力衰竭（21例中的14例）、体重减轻（21例中的12例）、贫血（19例中的6例）或血小板减少（19例中的6例）。所有患者均需抗生素治疗。21例患者中有15例接受了心脏手术。对于10例患者，血清学随访的几何平均值至少包括诊断时（抗I相IgG抗体1:27024，抗I相IgA抗体1:685）、治疗结束时（抗I相IgG抗体1:2941，抗I相IgA抗体1:153）以及治疗结束后6个月（抗I相IgG抗体1:368，抗I相IgA抗体1:40）的滴度。抗I相滴度下降显著。在临床和血清学随访期间（分别为60个月和69个月的中位时间），心内膜炎无复发，且针对伯纳特柯克斯体I相的抗体滴度保持较低水平。观察期间有2例患者死亡，1例死于肺癌，另1例死因不明。
血清学是Q热诊断的关键。治疗持续时间以及用于确定心内膜炎治愈的数值尚无明确界定。在临床和血清学随访期间（分别为60个月和69个月的中位时间），心内膜炎无复发，且针对伯纳特柯克斯体I相的抗体滴度保持较低水平。
