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PubMed1998

A guinea pig model for Q fever endocarditis.

A new model of experimental endocarditis, using electrocoagulation of native aortic valves, was used for the study of Q fever endocarditis. In the 20 guinea pigs electrocoagulated and inoculated with Coxiella burnetii Nine Mile phase I strain, 10 presented with infective endocarditis. Of these, 7 died spontaneously. All guinea pigs with endocarditis presented with blood cultures positive for C. burnetii, and C. burnetii antigen was found in their cardiac valves. Positive blood cultures or valvular immunopositive cells were not identified in either nonelectrocoagulated or noninoculated controls. This experimental model demonstrates that Q fever in an animal with previously damaged valves results in endocarditis. It could provide a new tool for the investigation of pathophysiology and antibiotic therapy for Q fever endocarditis.

Animals↗

PubMedDate not supplied

Experience with trimethoprim-sulfamethoxazole in treatment of infective endocarditis.

The published experience with trimethoprim-sulfamethoxazole (TMP-SMZ) for treatment of infective endocarditis was reviewed. Among 62 cases, a high proportion had unusual causative organisms: 60% of cases were due to Coxiella burnetii or Pseudomonas species. Only 17% of patients had previously normal cardiac valves. Patients often had complicated courses in which TMP-SMZ was tried only after other treatment regimens had failed, yet a successful outcome was achieved in 61% of cases. Thirty-five patients were treated with antibiotics alone, while the other 27 patients required combined medical and surgical management. TMP-SMZ has a limited role in the management of infective endocarditis; specific guidelines for its use, including proper laboratory control, have been delineated.

Anti-Infective Agents↗

PubMed1995

Infective endocarditis in patients with negative blood cultures: analysis of 88 cases from a one-year nationwide survey in France.

Blood cultures were negative in 88 (14%) of 620 cases of infective endocarditis (IE) documented in France during a 1-year nationwide survey. In 15 of these 88 cases, the causative microorganism was identified: seven cases of Q fever endocarditis and two cases of chlamydial endocarditis were diagnosed by serological and/or immunohistologic techniques, and a pathogen was cultured from five surgically removed valves and one arterial septic embolus. Forty-two (48%) of the 88 cases involved patients who had received antibiotics before the first blood sample was taken for culture. Mortality was lower in this group than among patients who had not previously received antibiotics (7% vs. 22%, P = .05). Comparison of blood culture-negative cases of IE with blood culture-positive cases revealed that the former tended to occur more often on prosthetic valves (32% vs. 22%, P = .16), were more often left-sided (97% vs. 83%, P = .0009), less often included extracardiac symptoms at presentation (52% vs. 63%, P = .06), and were more often surgically treated (53% vs. 34%, P = .001). Mortality was similar regardless of the results of blood culture (15% vs. 21%, P = .18). This study showed that more than 10% of all cases of IE in France are still associated with negative blood cultures and confirmed that a search for pathogens such as Coxiella burnetii and Chlamydia species is worthwhile in this situation.

Adolescent↗

PubMed1995

Mesangioproliferative glomerulonephritis and antibodies to phospholipids in a patient with acute Q fever: case report.

Glomerulonephritis is a rare complication of Q fever and is usually associated with the chronic form of disease, i.e., infectious endocarditis. We describe a 31-year-old man with a self-limited acute febrile illness due to Coxiella burnetii infection who had acute renal failure secondary to mesangioproliferative glomerulonephritis. Antibodies to phospholipids were detected and suggested the diagnosis of Q fever in this case.

Acute Disease↗

PubMed1996

Chlamydia pneumoniae as a cause of community-acquired pneumonia in hospitalized patients in Berlin.

The incidence of community-acquired pneumonia due to Chlamydia pneumoniae was evaluated in a 1-year prospective study of 236 hospitalized patients with 237 manifestations of pneumonia. The microbiological diagnosis was based on results of cultures of blood and sputum or bronchoalveolar lavage fluid and results of complement fixation tests and indirect immunofluorescence of acute- and convalescent-phase sera for C. pneumoniae, Mycoplasma pneumoniae, Legionella species, Coxiella burnetii, and respiratory viruses. Diagnosis of acute C. pneumoniae infection was made on the basis of the results of microimmunofluorescence of paired serum samples. A microbiological diagnosis was obtained in 160 cases (67.5%). C. pneumoniae was the causative agent in 27 patients (11.4%). The following organisms were the other etiologic agents of pneumonia: Streptococcus pneumoniae, 30 cases (12.7%) (bacteremia occurred in 53.3%); Mycoplasma pneumoniae, 22 (9.3%); respiratory viruses, 22 (9.3%); and Enterobacteriaceae, 18 (7.6%). The prevalence of C. pneumoniae antibody in our study population was 47.5%. As has been increasingly reported in recent years and confirmed by this study, C. pneumoniae appears to be a common etiologic agent of community-acquired pneumonia and upper respiratory tract infection in Germany.

Adolescent↗

PubMedDate not supplied

Q fever: current concepts.

Persons with Q fever usually present with severe retrobulbar headache, a fever to 104 degrees F or higher with shaking chills, general malaise, myalgia, chest pain, and sometimes pneumonia and hepatitis. Cattle, sheep, goats, and ticks are the primary reservoirs of the etiologic agent, Coxiella burnetii. Humans are usually infected by inhaling infectious aerosols. Because C. burnetii can survive for long periods in the environment, it poses a continuing health hazard once it is disseminated. Q fever usually occurs sporadically, but large outbreaks are frequently observed throughout the world, particularly among abattoir workers and personnel working in research centers. Q fever endocarditis follows a chronic course and is frequently fatal. Tests for antibodies to C. burnetii are required for confirmation of the diagnosis. Tetracyclines remain the mainstay of treatment for acute Q fever, and tetracyclines in combination with other antibiotics have been advocated for patients with Q fever endocarditis. Vaccines for Q fever have been proven effective in clinical trials.

Animals↗

PubMed1993

Q fever is absent from New Zealand.

To investigate the presence of Coxiella burnetii in sheep and cattle, the two major ruminant populations of New Zealand, its seroprevalence was determined in aborting cattle and sheepdogs. These groups of animals were chosen because of their accessibility and the fact that they would be good indicators for the presence of the organism. A total of 2181 bovine and 12,556 canine samples were all seronegative. On the basis of these results and previous reports it is argued that New Zealand is free of coxiellosis or Q fever.

Abortion, Veterinary↗

PubMed1981

Cryptic epidemic of Q fever in a medical school.

Pregnant sheep used in perinatel research were the source of a large outbreak of Q fever in 1980 among the faculty and staff of a medical school. Complement-fixation tests with phase II Coxiella burnetii antigen were positive in 81 persons, of whom 58 (71.6%) had Q fever during the first eight months of 1980. Microagglutination and/or indirect immunofluorescence tests of 485 sera were positive in an additional 56 persons. Only 41 of the 137 seropositive persons were involved in caring for or working with sheep; the remaining 96(70.1%) persons were located along the routes followed by sheep carts or had been exposed to sheep in other ways. Early in the outbreak few patients sought medical help. Later, most patients reported promptly and responded favorably to therapy with tetracycline. Sheep were removed from the campus in July 1980; cases ceased one month later. Other medical centers engaged in research with pregnant sheep should be alert to the risk of Q fever.

Animals↗

PubMed1987

Prosthetic valve endocarditis.

About 2% of patients with a prosthetic valve will develop endocarditis. This may occur within a few weeks of the valve replacement operation (early) or many months or years later (late). The infecting organisms, pathogenicity and prognosis differ in the two groups. The incidence of early prosthetic valve endocarditis (PVE) is under 1%; the predominant organisms are staphylococci that are acquired in the operating theatre or in the intensive therapy unit. Early PVE usually follows wound sepsis that may initially appear trivial. The mortality rate is around 70%, but such infections should be preventable by stringent antisepsis, good surgical technique and (perhaps) perioperative antistaphylococcal antibiotics. The incidence of late PVE is about 1% per annum. The infecting organisms are similar to those causing native valve endocarditis, predominantly streptococci. The commonest source of these organisms is the mouth and regular dental care and appropriate prophylactic antibiotics should help to prevent infection. The mortality rate of late PVE is around 10%. Failure of medical treatment in PVE is an indication for surgery to remove the infected valve(s) and this should not be delayed. The optimum length of treatment for PVE is unknown but it is seldom necessary to give antibiotics for more than 6 weeks except in Coxiella burnetii infection.

Adult↗

PubMed1987

Aetiology and epidemiology of infective endocarditis in England and Wales.

Comparing data relating to the estimated incidence of infective endocarditis and deaths due to this condition highlights the changing age and sex patterns over the last 50 years. Using these data it is estimated that about 20 cases per million population per year can now be expected many of whom will be aged 65 years or more. About 20% of cases die. Viridans streptococci are responsible for almost half the cases of endocarditis, faecal streptococci for 11%, staphylococci for 20% and Coxiella burnetii for 2-3%. The laboratory data for 1976-85 showed that 86 of 821 (10.5%) patients with Staphylococcus aureus endocarditis had valve prostheses and 55 (6.7%) were iv-drug abusers. Of the patients with endocarditis due to coagulase-negative staphylococci 100 of 361 (27.7%) had prostheses.

Adult↗

PubMed2005

Metagrowth: a new resource for the building of metabolic hypotheses in microbiology.

Metagrowth is a new type of knowledge base developed to guide the experimental studies of culture conditions of obligate parasitic bacteria. We have gathered biological evidences giving possible clues to the development of the axenic (i.e. 'cell-free') growth of obligate parasites from various sources including published literature, genomic sequence information, metabolic databases and transporter databases. The database entries are composed of those evidences and specific hypotheses derived from them. Currently, 200 entries are available for Rickettsia prowazekii, Rickettsia conorii, Tropheryma whipplei, Treponema pallidum, Mycobacterium tuberculosis and Coxiella burnetii. The web interface of Metagrowth helps users to design new axenic culture media eventually suitable for those bacteria. Metagrowth is accessible at http://igs-server.cnrs-mrs.fr/axenic/.

Bacteria↗

PubMed1986

Kawasaki syndrome: a controlled study of an outbreak in Wisconsin.

The etiology of Kawasaki syndrome remains unestablished, although a possible role has been suggested for exposure to the application of carpet shampoo, house dust mites, and rickettsial infection. During an outbreak of 20 cases of Kawasaki syndrome that occurred in southeastern Wisconsin from November 1982 through March 1983, a case-control study was done of 15 cases and 30 matched controls. The study included questionnaire administration, dust collection from homes, and serum specimen collection. Only one patient had been exposed to a shampooed carpet within 30 days before onset of illness. No differences were noted between cases and controls in the degree of exposure to house dust mite-associated factors in the home, nor in the occurrence, density and species-specific prevalence of house dust mites in the home. Meadow voles exposed to house dust mites from the homes of patients did not develop serologic or pathologic evidence of infection due to rickettsiae in the spotted fever and typhus groups or Coxiella burnetii. Anti-mite-specific immunoglobulin E was not detected in serum specimens from cases or controls. Results from this study do not support hypotheses suggesting that the development of Kawasaki syndrome is associated with exposure to application of carpet shampoo, house dust mites, or rickettsial infection.

Animals↗

PubMed1997

Prevalence of Q fever in a rural practice.

BACKGROUND: Q fever is a world-wide condition caused by the rickettsia Coxiella burnetii. It appears more prevalent in agrarian communities and may have serious sequelae. METHODS: A descriptive, cross-sectional, observational study using a randomly selected group of the adult working practice population in a rural practice in West Wales was devised. An immunofluorescence test, which identified past infection, was used to look for associations between C. burnetii seropositivity and farm-related or social activities, and to compare the findings with those of other studies. An attempt was made to establish a clinical profile for the illness Q fever. RESULTS: Twenty-one subjects were found to be seropositive to C. burnetii. No definite consistent clinical features were identified. Farming was undoubtedly a risk factor for the disease, maybe with other related factors also important. There was a possibility that alcohol had a protective effect. No sinister sequelae were described. CONCLUSIONS: Q fever occurs more frequently in farmers than in non-farmers, but was less common than previously thought. Is Q fever accurately described in medical textbooks? A case is made for a more co-operative approach between primary carers and epidemiologists in the study of illnesses in populations.

Agriculture↗

PubMed1987

The pathology of Q fever hepatitis. A case diagnosed by liver biopsy.

A 52-year-old woman with fever and low grade hepatitis had Q fever, a diagnosis made by the characteristic granulomas, containing fibrin and vacuoles, on liver biopsy and confirmed by serology. Fibrin was demonstrated in the granulomas but Coxiella burnetii antigens were not. The literature on the histopathology of the liver in both acute Q fever and Q fever endocarditis shows that none of the 220 cases of Q fever endocarditis, with one possible exception, had the characteristic granulomas of acute Q fever. Rather they displayed a range from normality through nonspecific reactive hepatitis to occasional nonspecific granulomas. Thus, the characteristic granulomas of acute Q fever appear to be transient even if active infection persists. The definition of chronic Q fever should have a temporal characteristic rather than a serologic one.

Female↗

PubMed2000

Q fever 1985-1998. Clinical and epidemiologic features of 1,383 infections.

In order to describe the clinical features and the epidemiologic findings of 1,383 patients hospitalized in France for acute or chronic Q fever, we conducted a retrospective analysis based on 74,702 sera tested in our diagnostic center, National Reference Center and World Health Organization Collaborative Center for Rickettsial Diseases. The physicians in charge of all patients with evidence of acute Q fever (seroconversion and/or presence of IgM) or chronic Q fever (prolonged disease and/or IgG antibody titer to phase I of Coxiella burnetii > or = 800) were asked to complete a questionnaire, which was computerized. A total of 1,070 cases of acute Q fever was recorded. Males were more frequently diagnosed, and most cases were identified in the spring. Cases were observed more frequently in patients between the ages of 30 and 69 years. We classified patients according to the different clinical forms of acute Q fever, hepatitis (40%), pneumonia and hepatitis (20%), pneumonia (17%), isolated fever (17%), meningoencephalitis (1%), myocarditis (1%), pericarditis (1%), and meningitis (0.7%). We showed for the first time, to our knowledge, that different clinical forms of acute Q fever are associated with significantly different patient status. Hepatitis occurred in younger patients, pneumonia in older and more immunocompromised patients, and isolated fever was more common in female patients. Risk factors were not specifically associated with a clinical form except meningoencephalitis and contact with animals. The prognosis was usually good except for those with myocarditis or meningoencephalitis as 13 patients died who were significantly older than others. For chronic Q fever, antibody titers to C. burnetii phase I above 800 and IgA above 50 were predictive in 94% of cases. Among 313 patients with chronic Q fever, 259 had endocarditis, mainly patients with previous valvulopathy; 25 had an infection of vascular aneurysm or prosthesis. Patients with endocarditis or vascular infection were more frequently immunocompromised and older than those with acute Q fever. Fifteen women were infected during pregnancy; they were significantly more exposed to animals and gave birth to only 5 babies, only 2 with a normal birth weight. More rare manifestations observed were chronic hepatitis (8 cases), osteoarticular infection (7 cases), and chronic pericarditis (3 cases). Nineteen patients were observed who experienced first a documented acute infection, then, due to underlying conditions, a chronic infection. To our knowledge, we report the largest series of Q fever to date. Our results indicate that Q fever is a protean disease, grossly underestimated, with some of the clinical manifestations being only recently reported, such as Q fever during pregnancy, chronic vascular infection, osteomyelitis, pericarditis, and myocarditis. Our data confirm that chronic Q fever is mainly determined by host factors and demonstrate for the first time that host factors may also play a role in the clinical expression of acute Q fever.

Age Distribution↗

PubMed2001

Community-acquired pneumonia. A prospective outpatient study.

We initiated a prospective study with a group of practitioners to assess the etiology, clinical presentation, and outcome of community-acquired pneumonia in patients diagnosed in the outpatient setting. All patients with signs and symptoms suggestive of pneumonia and an infiltrate on chest X-ray underwent an extensive standard workup and were followed over 4 weeks. Over a 4-year period, 184 patients were eligible, of whom 170 (age range, 15-96 yr; median, 43 yr) were included and analyzed. In 78 (46%), no etiologic agent could be demonstrated. In the remaining 92 patients, 107 etiologic agents were implicated: 43 were due to "pyogenic" bacteria (39 Streptococcus pneumoniae, 3 Haemophilus spp., 1 Streptococcus spp.), 39 were due to "atypical" bacteria (24 Mycoplasma pneumoniae, 9 Chlamydia pneumoniae, 4 Coxiella burnetii, 2 Legionella spp.), and 25 were due to viruses (20 influenza viruses and 5 other respiratory viruses). There were only a few statistically significant clinical differences between the different etiologic categories (higher age and comorbidities in viral or in episodes of undetermined etiology, higher neutrophil counts in "pyogenic" episodes, more frequent bilateral and interstitial infiltrates in viral episodes). There were 2 deaths, both in patients with advanced age (83 and 86 years old), and several comorbidities. Only 14 patients (8.2%) required hospitalization. In 6 patients (3.4%), the pneumonia episode uncovered a local neoplasia. This study shows that most cases of community-acquired pneumonia have a favorable outcome and can be successfully managed in an outpatient setting. Moreover, in the absence of rapid and reliable clinical or laboratory tests to establish a definite etiologic diagnosis at presentation, the spectrum of the etiologic agents suggest that initial antibiotic therapy should cover both S. pneumoniae and atypical bacteria, as well as possible influenza viruses during the epidemic season.

Adolescent↗

PubMed2001

Intractable Q fever treated with recombinant gamma interferon.

A 3-year-old boy with Q fever received several kinds of antibiotics including minocycline, but spiking fever and positive PCR of Coxiella burnetii continued for several months. He became asymptomatic and his abnormal laboratory data normalized after the administration of gamma interferon three times a week.

Child, Preschool↗

PubMed1998

Bartonella serology for patients with intraocular inflammatory disease.

PURPOSE: To determine the role of Bartonella henselae in intraocular inflammatory disease and identify its clinical features. METHODS: We retrospectively determined the serum immunoglobulin (Ig)G and IgM antibodies against B. henselae and Bartonella quintana by enzyme immunoassays in stored sera of 138 consecutive newly referred patients with uveitis who, during the acute stage of their ocular disease, underwent a standardized screening protocol to determine the cause of uveitis. RESULTS: For the entire series, the frequency of high positive levels of IgG (above 1:900) or IgM (above 1:300) antibody against B. henselae was 6% (8/138) and 3% (4/138), respectively. Except for cross-reactions between B. henselae and B. quintana, we did not find additional evidence for cross-reactions among the various bacteria tested (Coxiella burnetii and Chlamydia pneumoniae). All patients with proven infectious uveitis (n = 21) and those with established uveitic entities (n = 37) had negative B. henselae serology. High positive IgG levels were observed in 9% of patients (5/54) with unknown cause of uveitis, in two subjects with human leukocyte antigen (HLA)-B27 positive uveitis, and in one with sarcoidosis. Five patients with uveitis of unknown origin and highly elevated IgG levels against B. henselae exhibited clinical features characterized by papillitis with surrounding retinal focal lesions or edema. CONCLUSIONS: The serologic and clinical data indicate that uveitis in seropositive cases may be caused by B. henselae. We do not recommend including testing for B. henselae in initial screening of patients with uveitis, but consider it worthwhile for those with papillitis and screening results within normal limits.

Aged↗