BACKGROUND: Q-fever is considered endemic worldwide and endocarditis and/or vascular infection caused by Coxiella burnetii can be a fatal disease. We performed a retrospective study, to assess the indication for surgical treatment and outcome. We presented second large world series.
METHODS: We therefore studied all patients, who underwent valve surgery due to endocarditis and/or vascular infection in the cardiac surgical department of the large tertiary hospital.
RESULTS: During 9.5 year period, we performed a total of 158 valve procedure due to endocarditis and/or vascular infection. In the 13 cases (8.23%) Q-fever endocarditis was diagnosed. 9 patients had previous valvular surgery, 2 patients had aortic surgery and 2 patients had pre-existing valvular disease. Blood culture results remained negative in every patient. The diagnosis was assessed preoperatively in 9 patients and discovered postoperatively after routine bacterial and serological analysis of valve specimens in 4 patients. In all instances, Coxiella burnetii was identified by serological investigation. All patients received prolonged oral specific antibiotics (doxycycline and hydroxychloroquine) under serologic guidance. We observed no operative mortality and 1 in-hospital death.
CONCLUSIONS: Q fever endocarditis in Israel is quite frequent disease. Diagnosis is difficult and should be suspected in patients with abnormal native or prosthetic valves without leukocytosis and negative blood cultures. In such patients should prompt serologic testing. Surgical treatment is good option for Q fever endocarditis.
