INFECTIOUS ENDOCARDITIS WITH COXIELLA BURNETII

Q fever is caused by an anthropozoonosis determined by the pathogen Coxiella burnetii, a gram-negative bacterium with intracellular growth. The occurrence of infection in the human species takes place through inhalation of contaminated aerosols or dust from infected domestic animals (cattle, sheep, goats) and more rarely through ingestion of unpasteurized milk, infected mite or inter-human transmission. The endocardium is one of the main infection sites, especially in the context of the long-term development of the disease, and cardiac decompensation often leads to death in absence of a proper diagnosis and appropriate treatment (1).We present the case of a patient of the male sex aged 37 years without personal pathologic history known admitted in “St. Parascheva” Clinical Hospital for Infectious Diseases Iasi complaining of productive cough, fatigue, shortness of breath with moderate effort and pain in the left scapulohumeral joint with irradiation in the left upper limb. Clinical examination objectified digital clubbing, systolic/diastolic murmurs throughout the precordium area and hepato-splenomegaly, while laboratory tests revealed the presence of inflammatory syndrome, cholestasis and hepatic cytolysis. Echocardiography shows a hyperechogenic entity at the level of the aortic valve, as well as a severe valve disorder. The diagnosis of infective endocarditis is established on aortic valve and therapy with first-choice antibiotics, consisting of triple combination of cefotaxime, amikacin and vancomycin, is initiated. Blood cultures taken upon admission were negative, while positive serological phase I and II tests for C. burnetii urged the indication of changing therapy with doxycycline and trimethoprim sulfamethoxazole (in the absence of hydroxychloroquine). Subsequently he underwent aortic valve replacement. The particularities of this case consisted in atypical clinical manifestations, the absence of fever and epidemiological context suggestive for Q fever.