Volume 27, Number 8—August 2021
Dispatch
Screening for Q Fever in Patients Undergoing Transcatheter Aortic Valve Implantation, Israel, June 2018–May 2020
Nesrin Ghanem-Zoubi
, Mical Paul, Moran Szwarcwort, Yoram Agmon, and Arthur Kerner
, Mical Paul, Moran Szwarcwort, Yoram Agmon, and Arthur Kerner
Table
Characteristics of identified patients with Q fever infective endocarditis, Israel, June 1, 2018–May 31, 2020*
| Variable | Patient 1 | Patient 2 | Patient 3 | Patient 4 |
|---|---|---|---|---|
| Age, y/sex |
77/M |
52/F |
73/F |
79/M |
| Underlying conditions |
Hypertension, CAD, s/p CABG, and AVR (7 y) |
s/p Hodgkin lymphoma (30 y), DM, CAD, and s/p CABG (8 y) |
Scleroderma |
DM, hypertension, asthma |
| Habitat/exposure risk factor† |
Urban/none |
Urban/none |
Urban/none |
Urban/none |
| Indication for TAVI |
Symptomatic aortic insufficiency, NYHA 3/4 |
Symptomatic aortic stenosis and insufficiency (moderate to severe); chest pain and dyspnea with minimal effort |
Symptomatic severe aortic stenosis; recurrent syncope |
Symptomatic severe aortic stenosis, NYHA 3/4 |
| Echo findings before TAVI |
Moderate aortic stenosis and severe regurgitation with thickened leaflets |
Severe aortic stenosis |
Severe aortic stenosis with severe calcifications and moderate mitral regurgitation with leaflets sclerosis |
Severe aortic stenosis |
| Coxiella burnettii phase I IgG |
1:32,00 |
1:25,600 |
1:3,200 |
1:1,024 |
| C. burnettii PCR in blood |
Not performed |
Not performed |
Negative |
Not performed |
| Q fever IE according to modified Duke criteria |
Possible |
Possible |
Possible |
Possible |
| Q fever IE according to Dutch consensus guidelines |
Probable |
Probable |
Probable |
Probable |
| Treatment |
Doxycycline and hydroxychloroquine, changed to doxycycline and ciprofloxacin |
Doxycycline and hydroxychloroquine, changed to doxycyline monotherapy |
Doxycycline and hydroxychloroquine, changed to ciprofloxacin |
Doxycycline and hydroxychloroquine |
| Timing of and status at last follow-up | 18 mo, asymptomatic, preserved valve function, and stable serologic results | 8 mo, asymptomatic, preserved valve function, and stable serologic results | 12 mo, severe fatigue, preserved aortic valve function, and stable serologic results | 12 mo, asymptomatic, preserved valve function, and decreasing serologic results |
*AVR, aortic valve replacement; CABG, coronary artery bypass grafting; CAD, coronary artery disease; DM, diabetes mellitus; IE, infective endocarditis; NYHA, New York Heart Association (classification); s/p, status post; TAVI, transcatheter aortic valve implantation. †Risk factors for Q fever are employment as a veterinarian, farmer, abattoir worker, or any contact with farm animals.
Page created: June 10, 2021
Page updated: July 18, 2021
Page reviewed: July 18, 2021
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