@article{PAR00012815,
  title = {{L}atent {Q} {F}ever endocarditis in patients undergoing routine valve surgery},
  author = {{G}risoli, {D}. and {M}illion, {M}. and {E}douard, {S}. and {T}huny, {F}. and {L}epidi, {H}. and {C}ollart, {F}. and {H}abib, {G}. and {R}aoult, {D}idier},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground and aim of the study: {Q} fever is a worldwide zoonosis caused by a fastidious bacterium, {C}oxiella burnetii. {A} recent major outbreak of which in the {N}etherlands will most likely lead to the emergence of hundreds of cases of {C}. burnetii endocarditis during the next decade. {P}atients undergoing cardiac valve surgery may carry undiagnosed {Q} fever endocarditis with possible disastrous outcomes, and hence may benefit from a screening strategy. {T}he study aim was to evaluate the frequency of unsuspected latent {Q} fever endocarditis in patients undergoing routine valve surgery. {M}ethods: {A}t the present authors' institution, all resected cardiac valves/prostheses are examined routinely histologically, microbiologically and on a molecular biological basis, in addition to serological testing for fastidious microorganisms. {A} retrospective review was conducted of data relating to all patients who had unsuspected {Q} fever endocarditis that had been diagnosed after routine valve/prosthesis replacement/repair between 2000 and 2013 at the authors' institution. {R}esults: {A}mong 6,401 patients undergoing valve surgery, postoperative examinations of the explanted valves/prostheses led to an unexpected diagnosis of {Q} fever endocarditis in 14 cases (0.2%), who subsequently underwent appropriate medical treatments. {O}nly two of the patients (14%) had intraoperative findings suggestive of endocarditis. {O}n serological analysis of the blood samples, 11 patients (79%) presented an evocative {P}hase {I} {I}g{G} antibody titer >= 800. {V}alvular tissue-sample analyses yielded positive cultures and {PCR} in the same 13 patients (93%), whereas pathological and immunohistochemical examinations alone were suggestive of endocarditis in only seven dases (50%). {C}onclusion: {T}his screening strategy led to an unexpected diagnosis of {Q} fever endocarditis in 0.2% of patients undergoing routine valve surgery, who received subsequent appropriate antibiotic therapy. {S}ystematic serological analysis should be mandatory before performing heart valve surgery in countries where {C}. burnetii is endemic. {A} positive serology should lead to appropriate valve-specimen analyses, including microbiological, molecular biological and histological evaluations.},
  keywords = {},
  booktitle = {},
  journal = {{J}ournal of {H}eart {V}alve {D}isease},
  volume = {23},
  numero = {6},
  pages = {735--743},
  ISSN = {0966-8519},
  year = {2014},
  URL = {https://www.documentation.ird.fr/hor/{PAR}00012815},
}