Miljak T, Schmeiser T, Hofgärtner F, Sigel H
Medizinische Klinik I, Klinik am Eichert, Göppingen.
Dtsch Med Wochenschr. 1998 Oct 16;123(42):1235-8. doi: 10.1055/s-2007-1024162.
A 53-year-old patient had a prosthetic valve (St. Jude Medical 25) 9 years ago because of a Staphylococcus aureus endocarditis with severe aortic regurgitation. An initially mild, progressively more severe, aortic regurgitation then developed as a result of an empty paravalvular abscess cavity, requiring another valve replacement. Fever started on the 3rd postoperative day and persisted despite combined treatment with beta-lactam antibiotics and aminoglycoside.
At first no infectious focus could be identified radiologically or by echocardiography. But transoesophageal echocardiography revealed vegetations in the old abscess cavity. Several blood cultures were negative, while serological tests gave markedly raised antibody titers against Coxiella burnetii.
DIAGNOSIS, TREATMENT AND COURSE: Assuming Coxiella burnetii endocarditis the patient was given doxycycline, 2 x 100 mg daily and cotrimoxazole, 1 x 960 mg daily. The fever subsided and the vegetations had disappeared after four weeks. Because of the high risk of recurrence the antibiotic treatment was to be continued for two years.
Coxiella burnetii should be considered as a possible cause of fever of unknown origin, especially in patients with existing or operated cardiac valvar defects, when endocarditic vegetations have been demonstrated and several blood cultures have been negative.
一名53岁患者9年前因金黄色葡萄球菌性心内膜炎伴严重主动脉瓣反流接受了人工瓣膜置换术（圣犹达医疗公司25号瓣膜）。由于瓣周脓肿腔空虚，最初轻度的主动脉瓣反流逐渐加重，需要再次进行瓣膜置换。术后第3天开始发热，尽管联合使用了β-内酰胺类抗生素和氨基糖苷类抗生素，发热仍持续。
起初，影像学检查或超声心动图均未发现感染病灶。但经食管超声心动图显示旧脓肿腔内有赘生物。多次血培养均为阴性，而血清学检查显示针对伯氏考克斯体的抗体滴度显著升高。
诊断、治疗及病程：考虑为伯氏考克斯体性心内膜炎，给予患者强力霉素，每日2次，每次100mg，复方新诺明，每日1次，每次960mg。四周后发热消退，赘生物消失。由于复发风险高，抗生素治疗需持续两年。
伯氏考克斯体应被视为不明原因发热的可能病因，尤其是在已有或接受过心脏瓣膜缺损手术的患者中，当已证实有心内膜炎赘生物且多次血培养阴性时。
