Ten-year experience of Q fever endocarditis in a tertiary cardiac center in Saudi Arabia.
Adolescent
Adult
Anti-Bacterial Agents
/ therapeutic use
Child
Doxycycline
/ therapeutic use
Endocarditis, Bacterial
/ diagnosis
Female
Heart Diseases
/ congenital
Humans
Hydroxychloroquine
/ therapeutic use
Jugular Veins
/ surgery
Male
Medical Records
Middle Aged
Q Fever
/ complications
Retrospective Studies
Risk Factors
Saudi Arabia
/ epidemiology
Tertiary Care Centers
Young Adult
Congenital heart disease
Jugular vein
Middle East
Q fever endocarditis
Journal
International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases
ISSN: 1878-3511
Titre abrégé: Int J Infect Dis
Pays: Canada
ID NLM: 9610933
Informations de publication
Date de publication:
Nov 2019
Nov 2019
Historique:
received:
09
04
2019
revised:
21
06
2019
accepted:
29
07
2019
pubmed:
6
8
2019
medline:
29
1
2020
entrez:
6
8
2019
Statut:
ppublish
Résumé
Q fever endocarditis (QFE) is considered rare in the Middle East, with only a few cases reported in Saudi Arabia. The aim of this study is to report on the experience of our centre on QFE. We searched the medical records for cases of QFE at our cardiac center from 2009-2018. Demographic data, clinical features, serology and echocardiography results, treatments, and outcomes were assessed. Five hundred and two cases of infective endocarditis were detected over the 10 years period. Among the 234 patients with blood culture-negative endocarditis (BCNE), 19 (8.10%) had QFE. All patients had a previously diagnosed congenital heart disease except for one patient with rheumatic heart disease. Eleven patients had received a bovine jugular vein-related implant, e.g., a Melody valve (seven patients) or Contegra conduit (four patients). Coinfection was detected in three patients, and immunologic and embolic phenomena were observed in five patients. All patients received a combination of hydroxychloroquine and doxycycline, with good outcomes. Only two patients required surgery while on treatment. Two patients died several months after treatment; the cause of death was not identified. This study indicates that Q fever exists in our population. The majority of the patients had congenital heart disease (CHD) and underwent bovine jugular vein implants. Patients with CHD are at increased risk of infective endocarditis. Bovine jugular vein implants increase the risk of infective and possibly QFE. Proper exclusion of Q fever is warranted in all BCNE and possibly in culture-positive endocarditis cases in areas endemic to Q fever. We presented the largest series of Q fever endocarditis cases in Saudi Arabia. We showed that Q fever is not rare in the Middle East and suggest that it should be considered in all blood culture-negative endocarditis cases.
Sections du résumé
BACKGROUND
BACKGROUND
Q fever endocarditis (QFE) is considered rare in the Middle East, with only a few cases reported in Saudi Arabia. The aim of this study is to report on the experience of our centre on QFE.
METHODS
METHODS
We searched the medical records for cases of QFE at our cardiac center from 2009-2018. Demographic data, clinical features, serology and echocardiography results, treatments, and outcomes were assessed.
RESULTS
RESULTS
Five hundred and two cases of infective endocarditis were detected over the 10 years period. Among the 234 patients with blood culture-negative endocarditis (BCNE), 19 (8.10%) had QFE. All patients had a previously diagnosed congenital heart disease except for one patient with rheumatic heart disease. Eleven patients had received a bovine jugular vein-related implant, e.g., a Melody valve (seven patients) or Contegra conduit (four patients). Coinfection was detected in three patients, and immunologic and embolic phenomena were observed in five patients. All patients received a combination of hydroxychloroquine and doxycycline, with good outcomes. Only two patients required surgery while on treatment. Two patients died several months after treatment; the cause of death was not identified.
CONCLUSION
CONCLUSIONS
This study indicates that Q fever exists in our population. The majority of the patients had congenital heart disease (CHD) and underwent bovine jugular vein implants. Patients with CHD are at increased risk of infective endocarditis. Bovine jugular vein implants increase the risk of infective and possibly QFE. Proper exclusion of Q fever is warranted in all BCNE and possibly in culture-positive endocarditis cases in areas endemic to Q fever.
KEY POINTS
CONCLUSIONS
We presented the largest series of Q fever endocarditis cases in Saudi Arabia. We showed that Q fever is not rare in the Middle East and suggest that it should be considered in all blood culture-negative endocarditis cases.
Identifiants
pubmed: 31382048
pii: S1201-9712(19)30321-2
doi: 10.1016/j.ijid.2019.07.035
pii:
doi:
Substances chimiques
Anti-Bacterial Agents
0
Hydroxychloroquine
4QWG6N8QKH
Doxycycline
N12000U13O
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
21-26Informations de copyright
Copyright © 2019 The Author(s). Published by Elsevier Ltd.. All rights reserved.