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BACKGROUND AND AIM OF THE STUDY: Q fever, caused by the rickettsia Coxiella burnetii, is a worldwide zoonotic disease with both acute and chronic manifestations. Endocarditis is the principal chronic manifestation. Q fever can easily be mistaken for degenerative valve disease due to its indolent presentation, the fastidious nature of the organism (routine cultures are negative), and the absence of a typical echocardiographic and macroscopic appearance for endocarditis. Prosthetic valve failure, with associated morbidity and mortality, have been described following unrecognized infections. METHODS: Previous studies have documented the value of screening strategies in areas of high prevalence. Hence, a pilot study was conducted in a low-prevalence setting, in which 139 patients at two tertiary cardiac centers attending for elective valve replacement for degenerative valvular disease underwent testing for chronic Q fever infection by serological and molecular methods on blood and valve tissue. RESULTS: Five patients (3.7%) had serological evidence of past exposure to Q fever (consistent with rates in the literature). None had evidence of chronic Q fever endocarditis. The cost of adopting a universal screening strategy is around £40,000 per case (if serology is used to screen patients prior to surgery). CONCLUSIONS: Alternative and more cost-effective methods for identifying clinically quiet cases of chronic Q fever endocarditis are required.

Type

Journal article

Journal

J Heart Valve Dis

Publication Date

05/2016

Volume

25

Pages

375 - 379

Keywords

Bacteriological Techniques, Coxiella burnetii, DNA, Bacterial, Endocarditis, Bacterial, Heart Valve Diseases, Heart Valve Prosthesis Implantation, Heart Valves, Humans, Pilot Projects, Polymerase Chain Reaction, Predictive Value of Tests, Prevalence, Q Fever, Seroepidemiologic Studies, Serologic Tests, Tertiary Care Centers, United Kingdom