@article{PAR00010936,
  title = {{P}ersistence of {DNA} in a cured patient and positive culture in cases with low antibody levels bring into question diagnosis of {Q} fever endocarditis},
  author = {{E}douard, {S}. and {M}illion, {M}. and {L}epidi, {H}. and {R}olain, {J}. {M}. and {F}ournier, {P}. {E}. and {L}a {S}cola, {B}. and {G}risoli, {D}. and {R}aoult, {D}idier},
  editor = {},
  language = {{ENG}},
  abstract = {{W}e evaluated the performance of tools for diagnosing {Q} fever cardiovascular infection. {W}e retrospectively analyzed 162 cardiovascular samples from 125 patients who were tested serologically by immunofluorescence, quantitative {PCR} (q{PCR}), 16{S} r{RNA} gene amplification, culture, and immunohistochemistry, and we assessed the viability of {C}oxiella burnetii by measuring the transcription of the 16{S} r{RNA} gene. {T}he q{PCR} technique was significantly more sensitive than 16{S} r{RNA} gene amplification ({P} < 0.0001), cell culture ({P} = 0.0002), and immunohistochemistry ({P} < 0.0001). {T}he sensitivity of these techniques was reduced when applied to patients who had been previously treated. {T}he severity of infection appears to be correlated with phase {I} {I}g{G} levels. {W}e report for the first time 4 cases of endocarditis with positive q{PCR} and/or culture assay result from patients with a low phase {I} {I}g{G} ({I}g{G} {I}) titer (<800), and we have identified the longest (16 years) persistence of {DNA} described in a heart valve from a patient cured after being previously treated for endocarditis. {T}he active transcription of the 16{S} r{RNA} gene was found in 19/59 tested samples, with a positive predictive value of 100% for a positive culture. {I}n conclusion, the diagnosis of {Q} fever cardiovascular infection should not be excluded in patients with low titers of phase {I} {I}g{G} when they present with valvulopathy. {W}e recommend testing cardiovascular samples using 3 or 4 different biopsy sections by q{PCR} evaluation for patients with {I}g{G} {I} titers of >= 200.},
  keywords = {},
  booktitle = {},
  journal = {{J}ournal of {C}linical {M}icrobiology},
  volume = {51},
  numero = {9},
  pages = {3012--3017},
  ISSN = {0095-1137},
  year = {2013},
  DOI = {10.1128/jcm.00812-13},
  URL = {https://www.documentation.ird.fr/hor/{PAR}00010936},
}