Author(s): Million M, Walter G, Thuny F, Habib G, Raoult D
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Abstract BACKGROUND: The prevention of Q fever endocarditis through the use of systematic echocardiography and antibiotic prophylaxis in patients with acute Q fever and valvulopathy has never been validated in a cohort study. METHODS: From 2007 to 2012, all patients followed at the French National Referral Center for acute Q fever were included in a cohort study. The prevention of endocarditis included a systematic transthoracic echocardiography (TTE) and a 12-month course of doxycycline and hydroxychloroquine prophylaxis in patients with significant valvulopathy. Transesophageal echocardiography (TEE) was performed in patients with a negative TTE and a rapid rise of phase I immunoglobulin G titers. RESULTS: Seventy-two patients were included with a median follow-up time of 22 months. A valvulopathy was identified in 31 patients (43\%), being previously unknown in 24 (33\%) and diagnosed only upon TEE or a second TTE in 7 (10\%). The major determinants associated with endocarditis were age (hazard ratio [HR], 1.07; 95\% confidence interval [CI], 1.006-1.13; P = .03), aortic regurgitation (HR, 10.2; 95\% CI, 3.2-32.2; P < .001), and mitral regurgitation (HR, 4.78; 95\% CI, 1.4-16.0; P = .01). Antibiotic prophylaxis was highly effective (HR, 0.002; 95\% CI, .00-.77; P = .04) for the 31 patients with valvulopathy. CONCLUSIONS: Acute Q fever could be associated with an increased prevalence of valvulopathy. The evolution from acute Q fever to endocarditis is associated with age and valvulopathy and can be entirely prevented by antibiotic prophylaxis. Although the name "chronic Q fever" suggests otherwise, rapid evolution (<1 month) was observed.
This article was published in Clin Infect Dis
and referenced in Journal of Tropical Diseases & Public Health