Document Detail


Long-term outcome of Q fever endocarditis: a 26-year personal survey.
MedLine Citation:
PMID:  20637694     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Q fever endocarditis caused by Coxiella burnetii is a potentially fatal disease characterised by a chronic evolution. To assess the long-term outcome and identify prognostic factors for mortality, surgical treatment, and serological changes in Q fever endocarditis, we did a retrospective study in the French National Referral Centre.
METHODS: Patients included were diagnosed with Q fever endocarditis at our centre from May, 1983, to June, 2006, and followed up for a minimum of 3 years for each patient, history and clinical characteristics were recorded with a standardised questionnaire. Prognostic factors associated with death, surgery, serological cure, and serological relapse were assessed by Cox regression analysis. Excised heart valve analysis was assessed according to duration of treatment.
FINDINGS: 104 patients were identified for inclusion in the study, although one was lost to follow-up; median follow-up was 100 months (range 37-310 months). 18 months of treatment was sufficient to sterilise the valves of all the patients except three, and 2 years of treatment sterilised all valves except one. In a multivariate Cox regression analysis, the major determinants associated with mortality were age (hazard ratio 1.11, 95% CI 1.05-1.18, p=0.003), stroke at diagnosis (7.09, 2.00-25.10, p=0.001), endocarditis on a prosthetic valve (6.04, 1.47-24.80, p=0.044), an absence of a four-times decrease of phase I IgG and IgA at 1 year (5.69, 1.00-32.22, p=0.049), or the presence of phase II IgM at 1 year (12.08, 3.11-46.85, p=0.005). Surgery was associated with heart failure (2.68, 1.21-5.94, p=0.015) or a cardiac abscess (4.71, 1.64-13.50, p=0.004). The determinants of poor serological outcome were male sex (0.47, 0.26-0.86, p=0.014), a high level of phase I IgG (0.65, 0.45-0.95, p=0.027), and a delay in the start of treatment with hydroxychloroquine (0.20, 0.04-0.91, p=0.037). Factors associated with relapse were endocarditis on a prosthetic valve (21.3, 2.05-221.86, p=0.01) or treatment duration less than 18 months (9.69, 1.08-86.72, p=0.042).
INTERPRETATION: The optimum duration of treatment with doxycycline and hydroxychloroquine in Q fever endocarditis is 18 months for native valves and 24 months for prosthetic valves. This duration should be extended only in the absence of favourable serological outcomes. Patients should be serologically monitored for at least 5 years because of the risk of relapse.
FUNDING: French National Referral Centre for Q Fever.
Authors:
Matthieu Million; Franck Thuny; Hervé Richet; Didier Raoult
Related Documents :
7948524 - Group b streptococcal endocarditis involving the tricuspid valve in a 7-month-old infant.
10660174 - Randomized controlled trial of stented and stentless aortic bioprotheses: hemodynamic p...
810904 - Atrioventricular valve replacement with the hancock porcine xenograft: a five year clin...
7441274 - Clinical and prognostic correlates of eeg in open-heart surgery patients.
22541064 - Impact of age over 75 years on outcomes after pancreaticoduodenectomy.
24275524 - Tissue engineered bulking agent with adipose-derived stem cells and silk fibroin micros...
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-07-14
Journal Detail:
Title:  The Lancet. Infectious diseases     Volume:  10     ISSN:  1474-4457     ISO Abbreviation:  Lancet Infect Dis     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-07-30     Completed Date:  2010-08-31     Revised Date:  2014-08-15    
Medline Journal Info:
Nlm Unique ID:  101130150     Medline TA:  Lancet Infect Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  527-35     Citation Subset:  IM    
Copyright Information:
2010 Elsevier Ltd. All rights reserved.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Antibodies, Bacterial / blood
Doxycycline / therapeutic use
Endocarditis, Bacterial / diagnosis,  mortality,  therapy*
Female
Humans
Immunoglobulin G / blood
Male
Middle Aged
Polymerase Chain Reaction
Prognosis
Proportional Hazards Models
Q Fever / diagnosis,  mortality,  therapy*
Retrospective Studies
Treatment Outcome
Chemical
Reg. No./Substance:
0/Antibodies, Bacterial; 0/Immunoglobulin G; N12000U13O/Doxycycline
Comments/Corrections
Comment In:
Lancet Infect Dis. 2010 Aug;10(8):507-9   [PMID:  20637695 ]
Lancet Infect Dis. 2011 Feb;11(2):82-3   [PMID:  21272791 ]
Lancet Infect Dis. 2011 Feb;11(2):81; author reply 82   [PMID:  21272788 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Management of 273 cases of recurrent implantation failure: results of a combined evidence-based prot...
Next Document:  Q fever endocarditis.