Prosthetic valve endocarditis due to Coxiella burnetii: six cases.

Purpose. - Prosthetic valve endocarditis is a dangerous complication of val vular surgery (3-6%). Among involved pathogens, Coxiella burnetii is an occ asional agent, though isolated with increasing frequency. We report our exp erience with this peculiar endocarditis and lay stress on specific diagnost ic and therapeutic difficulties. Methods. - Between 1990 and 1995, six patients retrospectively met the diag nosis criteria for definite endocarditis due to Coxiella burnetii. Results. - Five Algerian men and one French woman presented with prosthetic valve endocarditis with negative blood cultures (on bioprosthesis: four ca ses, on mechanical valve: two cases). The main clinical and biological feat ure was febrile congestive heart failure with hepatomegaly, splenomegaly, h epatic and renal abnormalities, inflammatory syndrome, hypergammaglobulinem ia, anemia and lymphopenia. Serological testing for Coxiella burnetii provi ded diagnosis in all cases. Echocardiography displayed vegetations in all c ases. Valvular replacement was performed in four patients. With antibiotic therapy including doxycycline or/and hydroxychloroquine, quinolones or rifa mpicine, all patients experienced complete clinical, biological and echogra phic remission. Conclusion. - Q fever prosthetic valve endocarditis presents as a systemic disorder occurring in patients with valvular heart disease. From now on, ea rly diagnosis and efficient medical treatment may provide permanent prosthe tic sterilization. (C) 2001 Editions scientifiques et medicales Elsevier SA S.