Endocarditis due to Q fever in Nova Scotia: experience with five patients in 1981-1982.
Endocarditis due to Q fever in Nova Scotia: experience with five patients in 1981-1982.
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新斯科舍省 Q 热引起的心内膜炎：1981-1982 年 5 名患者的经验。
DOI：
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发表时间：
1983
影响因子：
6.4
通讯作者：
T. Montague
中科院分区：
文献类型：
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作者：
E. Haldane;T. Marrie;R. Faulkner;S. H. Lee;J. H. Cooper;D. MacPherson;T. Montague
Q热心内膜炎在北美很少报告，自1953年以来只有4例病例记录。1981-1982年，在新斯科舍省哈利法克斯的维多利亚总医院发现了5个病例。四名患者来自新斯科舍省相距甚远的地区，一名来自爱德华王子岛。4例长期存在瓣膜异常的患者，包括2例人工瓣膜患者，出现反复发热。第5例患者之前情况良好，但出现复发性脓毒性栓塞发作。临床特征和实验室检查结果各不相同。通过血清学诊断证实了4例患者的贝氏柯克斯体从切除的组织培养。组织学从非特异性炎症变化到两种更独特的模式;电子显微镜显示两例患者的贝氏隐球菌。四环素和甲氧苄啶-磺胺甲恶唑治疗是有益的，虽然三名患者需要瓣膜置换术的血流动力学恶化。Q热心内膜炎可能比公认的更常见，所有培养阴性的心内膜炎病例都应进行血清学检查。
Q fever endocarditis is rarely reported in North America; only four cases have been documented since 1953. In 1981-1982, five cases were identified in the Victoria General Hospital, Halifax, Nova Scotia. Four patients were from widely separated areas of Nova Scotia and one was from Prince Edward Island. Four patients with long-standing valvular abnormalities, including two with prosthetic valves, presented with recurrent febrile episodes. The fifth patient, who was previously well, had recurrent septic embolic episodes. Clinical features and laboratory findings were variable. Diagnosis by serology was confirmed in four patients by culture of Coxiella burnetii from excised tissue. Histopathology varied from nonspecific inflammatory changes to two more distinctive patterns; electron microscopy showed C burnetii in two patients. Therapy with tetracycline and trimethoprim-sulfamethoxazole was beneficial, although three patients required valve replacement for hemodynamic deterioration. Q fever endocarditis may be more common than is recognized, and serological investigations should be performed in all cases of culture-negative endocarditis.