Molecular detection of Coxiella burnetii in heart valve tissue from patients with culture-negative infective endocarditis
- Authors
- Jang, Young-Rock; Song, Joon Seon; Jin, Choong Eun; Ryu, Byung-Han; Park, Se Yoon; Lee, Sang-Oh; Choi, Sang-Ho; Kim, Yang Soo; Woo, Jun Hee; Song, Jae-Kwan; Shin, Yong; Kim, Sung-Han
- Issue Date
- Aug-2018
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS
- Keywords
- diagnosis; endocarditis; polymerase chain reaction; Q fever
- Citation
- MEDICINE, v.97, no.34
- Journal Title
- MEDICINE
- Volume
- 97
- Number
- 34
- URI
- https://scholarworks.bwise.kr/gachon/handle/2020.sw.gachon/3521
- DOI
- 10.1097/MD.0000000000011881
- ISSN
- 0025-7974
- Abstract
- Coxiella burnetii is a common cause of blood culture-negative infective endocarditis (IE). Molecular detection of C burnetii DNA in clinical specimens is a promising method of diagnosing Q fever endocarditis. Here, we examined the diagnostic utility of Q fever polymerase chain reaction (PCR) of formalin-fixed heart valve tissue from patients with blood culture-negative IE who underwent heart valve surgery. Clinical and laboratory data of patients with blood culture-negative IE who underwent heart valve surgery during a 6-year period and for whom biopsy tissues were available were reviewed retrospectively. Blood culture-positive IE patients who underwent heart valve surgery within the last 3 years were used as controls. Heart valve samples were cultured and also subjected to histological examination and PCR for Q fever, brucellosis, and bartonellosis. Data from 20 patients with blood culture-negative IE and 20 with blood culture-positive IE were analyzed. Eight cases of blood culture-negative IE were PCR-positive for C burnetii (40%; 95% confidence interval, 19-64). No specimen was PCR-positive for brucellosis or bartonellosis. Histologically, 4 of 8 specimens with a positive Q fever PCR result were characterized by clusters of multinucleated giant cells without a fibrin ring. None of 20 patients with blood culture-negative IE received anti-Coxiella antibiotic therapy due to lack of clinical suspicion. Six-month mortality was higher in the Q fever PCR-positive group than in the Q fever PCR-negative group [38% (3/8) vs 0% (0/12), P = .049). Of the 20 patients with blood culture-positive IE, none yielded a positive Q fever PCR result for valve tissue. Approximately 40% of patients with culture-negative IE who received heart valve surgery were PCR-positive for Q fever; patients without clinical suspicion suffered high mortality. These data suggest that Q fever IE in patients with culture-negative IE is often missed in routine clinical practice.
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