Immunoglobulin G anticardiolipin antibodies and progression to Q fever endocarditis

2013

Article référencé dans le Web of Science WOS:000320923700010

Million M., Walter G., Bardin N., Camoin L., Giorgi R., Bongrand P., Gouriet F., Casalta J. P., Thuny F., Habib G., Raoult Didier

Clinical Infectious Diseases, 2013, 57 (1), p. 57-64 ISSN 1058-4838

Background. Immunoglobulin G (IgG) anticardiolipin (aCL) antibodies are associated with valvulopathy and endocarditis in patients with lupus and other diseases. During acute Q fever, high IgG aCL prevalence has been reported, but the clinical significance remains unknown. Methods. To test if increased IgG aCL at acute Q fever diagnosis is associated with an increased risk of progression to endocarditis, all patients diagnosed in the French National Referral Center for Q fever from January 2007 to December 2011 were included and followed regularly until January 2013 in a 5-year prospective cohort study. Q fever endocarditis was defined according to recently updated criteria. Results. Seventy-two patients were followed for a median time of 31 months (interquartile range, 18-47 months). Of these, 13 patients with valvulopathy without antibiotic prophylaxis progressed to endocarditis. IgG aCL levels were highly prevalent (57%) and significantly higher in the presence of a valvulopathy (P =.005). Using Cox regression analysis, highly increased levels of IgG aCL (adjusted hazard ratio [AHR], 12.95; 95% confidence interval, 2.85-58.95; P =.001) and high levels of phase II immunoglobulin M (IgM; AHR, 6.59; 95% CI, 1.37-31.62; P =.018) were the only independent predictors of progression to endocarditis. Conclusions. Rapid progression from acute Q fever to endocarditis is associated with high levels of IgG aCL and high levels of phase II IgM, findings that should be critical in the prevention of endocarditis.

Santé : généralités [050] ; Entomologie médicale / Parasitologie / Virologie [052]

PAR00010729