Resume Propos. – Les endocardites sur prothese representent une complication redoutable de la chirurgie de remplacement valvulaire (3–6 %). Parmi les bacteries responsables, Coxiella burnetii occupe une place modeste mais en pleine expansion. Nous rapportons notre experience de cette endocardite particuliere, en insistant sur les difficultes diagnostiques et therapeutiques qu’elle souleve. Methodes. – Entre 1990 et 1995, six patients ont repondu retrospectivement aux criteres diagnostiques d’endocardite certaine a Coxiella burnetii. Resultats. – Les patients, cinq hommes algeriens et une femme francaise, ont presente une endocardite a hemocultures negatives sur prothese (bioprothese : quatre cas, prothese mecanique : deux cas). Le tableau clinicobiologique comportait generalement une insuffisance cardiaque febrile avec hepatomegalie, splenomegalie, anomalies biologiques hepatiques et renales, syndrome inflammatoire, hypergammaglobulinemie, anemie et lymphopenie. La serologie a apporte le diagnostic dans tous les cas. L’echocardiographie a constamment montre des vegetations. Un remplacement valvulaire a ete pratique chez quatre patients. L’antibiotherapie associant doxycycline ± hydroxychloroquine, quinolone ou rifampicine, a permis une remission clinique, biologique et echographique chez tous les patients. Conclusions. – L’endocardite de la fievre Q sur prothese se presente comme une maladie systemique chez un patient valvulaire. Desormais, un diagnostic et un traitement medical precoces permettent d’esperer une sterilisation valvulaire definitive.

Endocardites à Coxiella burnetii sur prothèse : six observations

Nous rapportons le cas d'un patient porteur d'une fievre Q chronique responsable d'une atteinte valvulaire aortique

Fièvre Q, insuffisance aortique, hypersplénisme et composant monoclonal

The worldwide epidemiology and population-based incidence of Q fever endocarditis (QFE) have been less well studied than those for uncomplicated Q fever. An exhaustive literature review revealed 408 patients with QFE reported between 1949 and 1994, mostly from 3 large geographic areas. Underlying valvular heart disease was almost invariably present, and 38% had prosthetic valves. The most common clinical manifestations were fever and congestive heart failure. The mortality rate dropped over the years from 65% to 25%, but a meta-analysis of published data showed the death rate to be significantly lower among patients receiving combination therapy (12/65, 18%), as compared to patients treated with tetracycline alone (18/41, 44%, p = 0.005). A 10-year (1983-1992) retrospective nationwide survey of QFE in Israel revealed 35 patients with QFE, representing an annual incidence of 0.75 cases per 1 million population. Underlying heart disease, clinical manifestations and outcome in the Israeli group were not substantially different from those described in the world literature. The current state-of-the-art clinical approach includes early diagnosis, prompt initiation of combination therapy for at least 3 years, and long-term clinical and serologic follow-up. Adherence to these rules might have contributed to the improved prognosis in recent years.

Q fever endocarditis in Israel and a worldwide review

An acute infectious disease with predominant pulmonary symptoms, Q fever, may become chronic as hepatitis or, more frequently, endocarditis We report 3 cases of Q fever endocarditis In 2 of these patients endocarditis developed on cardiac valve prosthesis The 3 patients have been under doxycycline for more than a year, and their condition is satisfactory A review of the literature provides additional data on the epidemiological, aetiological, clinical, biological and therapeutic aspects of this rare type of endocarditis It is recommended to look for chronic Q fever in all cases of endocarditis with negative blood cultures

Q fever infectious endocarditis. 3 cases

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Q fever infectious endocarditis. 3 cases