Delayed Diagnosis of Chronic Q Fever and Cardiac Valve Surgery

Linda M. Kampschreur

, Elske Hoornenborg, Nicole H. M. Renders, Jan Jelrik Oosterheert, Joost F. Haverman, Peter Elsman, and Peter C. Wever

Author affiliations: University Medical Center Utrecht, Utrecht, the Netherlands (L.M. Kampschreur, J.J. Oosterheert); Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands (L.M. Kampschreur, E. Hoornenborg, N,H.M. Renders, J.F. Haverman, P. Elsman, P.C. Wever)

Abstract

Untreated chronic Q fever causes a high number of complications and deaths. We present cases of chronic Q fever that were not diagnosed until after the patients underwent cardiac valve surgery. In epidemic areas, Q fever screening of valve surgery patients secures early initiation of treatment and can prevent illness and death.

Q fever, a zoonosis caused by the intracellular gram-negative bacterium Coxiella burnetii, occurs in outbreaks and is prevalent worldwide. Q fever has acute and chronic stages (1). Acute Q fever is a self-limiting febrile disease occurring in 40%–50% of C. burnetii–infected persons (1). Chronic Q fever can develop years after primary infection and occurs in 1%–5% of C. burnetii–infected persons (1,2). The most critical manifestations of chronic Q fever are endocarditis and infections of vascular prosthesis and aortic aneurysms (3). Persons with pre-existing valvular cardiac disease have a reported 40% risk of Q fever endocarditis when infected with C. burnetii (2,4).
During 2007–2010, an outbreak of >4,000 cases of acute Q fever occurred in the Netherlands (5). To increase understanding of the role of Q fever in valvular cardiac disease, we present 3 cases of chronic Q fever and valvular cardiac disease requiring surgery in patients from the Netherlands. The diagnosis of chronic Q fever was not made until after the patients had elective cardiac valve surgery for progressive valvular dysfunction.