Coxiella burnetii infection of aortic aneurysms or vascular grafts: report of 30 new cases and evaluation of outcome

  • E. Botelho-Nevers
  • P.-E. Fournier
  • H. Richet
  • F. Fenollar
  • H. Lepidi
  • C. Foucault
  • A. Branchereau
  • P. Piquet
  • M. Maurin
  • D. Raoult


Q fever is a zoonotic disease caused by Coxiella burnetii. Polymorphic, the disease may present as an acute or chronic infection. Vascular infections are the second most common form of chronic Q fever, following endocarditis. Herein, we studied the outcome of 30 new cases of aortic infection caused by C. burnetii using uni- and multivariate analyses. The outcome of ten cases previously reported by our team was also updated. Of these 40 patients, 32 had a follow-up of ≥3 years. Among them, the overall mortality was of 25% (8/32). Vascular rupture was significantly and independently (multivariate P=0.03) associated with a lethal issue, whereas vascular surgery was significantly associated with recovery (uni- and multivariate P<0.01). Our findings demonstrate the critical importance of surgery in the management of C. burnetii vascular infections.



The authors are grateful to Drs. Alamartine, Becq-Giraudon, Besnier, Beytout, Bosseret, Bouchou, Cottin, Faux, Glichmanas, Hamidou, Heibel, Labrun, Martin, May, Millet, Perez, Raz, Tellez, and Vigier for providing clinical information, and Dr. Cutler for English revision.


  1. 1.
    Maurin M, Raoult D (1999) Q fever. Clin Microbiol Rev 12:518–553PubMedGoogle Scholar
  2. 2.
    Bellamy RJ, Freedman AR (2001) Bioterrorism. Q J Med 94:227–234Google Scholar
  3. 3.
    Raoult D, Tissot-Dupont H, Foucault C, Gouvernet J, Fournier PE, Bernit E, Stein A, Nesri M, Harle JR, Weiller PJ (2000) Q fever 1985–1998- Clinical and epidemiologic features of 1,383 infections. Medicine 79:109–123PubMedCrossRefGoogle Scholar
  4. 4.
    Raoult D (1990) Host factors in the severity of Q fever. Ann N Y Acad Sci 590:33–38PubMedCrossRefGoogle Scholar
  5. 5.
    Maurin M, Benoliel A, Bongrand P, Raoult D (1992) Phagolysosomal alkalinization and the bactericidal effect of antibiotics: the Coxiella burnetii paradigm. J Infect Dis 166:1097–1102PubMedGoogle Scholar
  6. 6.
    Mege JL, Maurin M, Capo C, Raoult D (1997) Coxiella burnetii: the “query” fever bacterium a model of immune subversion by a strictly intracellular microorganism. FEMS Microbiol Rev 19:209–217PubMedCrossRefGoogle Scholar
  7. 7.
    Raoult D, Marrie T, Mege J (2005) Natural history and pathophysiology of Q fever. Lancet Infect Dis 5:219–226PubMedCrossRefGoogle Scholar
  8. 8.
    Ellis ME, Smith CC, Moffat MA (1983) Chronic or fatal Q-fever infection: a review of 16 patients seen in North- East Scotland (1967–80). Q J Med 52:54–66PubMedGoogle Scholar
  9. 9.
    Fergusson RJ, Shaw TRD, Kitchin AH, Matthews MB, Inglis JM, Peutherer JF (1985) Subclinical chronic Q fever. Q J Med 57:669–676PubMedGoogle Scholar
  10. 10.
    Micoud M, Brion JP, Boulard JC et al (1991) Infection of aortic aneurysm with Coxiella burnetii. Lancet 338:584PubMedCrossRefGoogle Scholar
  11. 11.
    Piquet P, Raoult D, Tranier P, Mercier C. Coxiella burnetii infection of pseudoaneurysm of an aortic bypass graft with contiguous vertebral osteomyelitis. J Vasc Surg 19:165–168Google Scholar
  12. 12.
    Raoult D, Piquet P, Gallais H, De Micco C, Drancourt M, Casanova P (1986) Coxiella burnetii infection of a vascular prosthesis. N Engl J Med 315:1358–1359PubMedGoogle Scholar
  13. 13.
    Fournier PE, Casalta JP, Piquet P, Tournigand P, Branchereau A, Raoult D (1998) Coxiella burnetii infection of aneurysms or vascular grafts: report of seven cases and review. Clin Infect Dis 26:116–121PubMedGoogle Scholar
  14. 14.
    Sessa C, Vokrri L, Porcu P, Maurin M, Stahl JP, Magne JL (2005) Abdominal aortic aneurysm and Coxiella burnetii infection: report of three cases and review of the literature. J Vasc Surg 42:153–158PubMedCrossRefGoogle Scholar
  15. 15.
    Senn L, Franciolli M, Raoult D, Moulin A, von Segesser L, Calandra T, Greub G (2005) Coxiella burnetii vascular graft infection. BMC Infect Dis 5:109PubMedCrossRefGoogle Scholar
  16. 16.
    Mejia A, Toursarkissian B, Hagino RT, Myers JG, Sykes MT (2000) Primary aortoduodenal fistula and Q fever: an underrecognized association? Ann Vasc Surg 14:271–273PubMedCrossRefGoogle Scholar
  17. 17.
    Brouqui P, Tissot-Dupont H, Drancourt M, Berland Y, Etienne J, Leport C, Goldstein F, Massip P, Micoud M, Bertrand A, Raoult D (1993) Chronic Q fever. Ninety-two cases from France, including 27 cases without endocarditis. Arch Intern Med 153:642–648PubMedCrossRefGoogle Scholar
  18. 18.
    Raoult D, Houpikian P, Tissot DH, Riss JM, Arditi-Djiane J, Brouqui P (1999) Treatment of Q fever endocarditis: comparison of two regimens containing doxycycline and ofloxacin or hydroxychloroquine. Arch Intern Med 159:167–173PubMedCrossRefGoogle Scholar
  19. 19.
    Tissot-Dupont H, Thirion X, Raoult D (1994) Q fever serology: cutoff determination for microimmunofluorescence. Clin Diagn Lab Immunol 1:189–196Google Scholar
  20. 20.
    Raoult D, Vestris G, Enea M (1990) Isolation of 16 strains of Coxiella burnetii from patients by using a sensitive centrifugation cell culture system and establishment of strains in HEL cells. J Clin Microbiol 28:2482–2484PubMedGoogle Scholar
  21. 21.
    Raoult D, Laurent JC, Mutillod M. Monoclonal antibodies to Coxiella burnetii for antigenic detection in cell cultures and in paraffin-embedded tissues. Am J Clin Pathol 101:318–320Google Scholar
  22. 22.
    Fournier PE, Marrie TJ, Raoult D (1998) Diagnosis of Q fever. J Clin Microbiol 36:1823–1834PubMedGoogle Scholar
  23. 23.
    Lepidi H, Houpikian P, Liang Z, Raoult D (2003) Cardiac valves in patients with Q fever endocarditis: microbiological, molecular, and histologic studies. J Infect Dis 187:1097–1106PubMedCrossRefGoogle Scholar
  24. 24.
    Dean AG (2000) Epi Info and Epi Map: current status and plans for Epi Info. J Public Health Manag Pract 5:54–57Google Scholar
  25. 25.
    Musso D, Raoult D (1995) Coxiella burnetii blood cultures from acute and chronic Q-fever patients. J Clin Microbiol 33:3129–3132PubMedGoogle Scholar
  26. 26.
    Rolain JM, Boulos A, Mallet MN, Raoult D (2005) Correlation between ratio of serum doxycycline concentration to MIC and rapid decline of antibody levels during treatment of Q fever endocarditis. Antimicrob Agents Chemother 49:2673–2676PubMedCrossRefGoogle Scholar
  27. 27.
    Wanhainen A, Bergqvist D, Boman K, Nilsson TK, Rutegard J, Bjorck M (2005) Risk factors associated with abdominal aortic aneurysm: a population-based study with historical and current data. J Vasc Surg 41:390–396PubMedCrossRefGoogle Scholar
  28. 28.
    Al-Omran M, Verma S, Lindsay TF, Weisel RD, Sternbach Y (2004) Clinical decision making for endovascular repair of abdominal aortic aneurysm. Circulation 110:e517–e523PubMedCrossRefGoogle Scholar
  29. 29.
    Brewster DC, Cronenwett JL, Hallett JW Jr, Johnston KW, Krupski WC, Matsumura JS (2003) Guidelines for the treatment of abdominal aortic aneurysms. Report of a subcommittee of the Joint Council of the American Association for Vascular Surgery and Society for Vascular Surgery. J Vasc Surg 37:1106–1117PubMedCrossRefGoogle Scholar
  30. 30.
    Coselli JS, Conklin LD, LeMaire SA (2002) Thoracoabdominal aortic aneurysm repair: review and update of current strategies. Ann Thorac Surg 74:S1881–S1884PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • E. Botelho-Nevers
    • 1
  • P.-E. Fournier
    • 1
  • H. Richet
    • 1
  • F. Fenollar
    • 1
  • H. Lepidi
    • 1
  • C. Foucault
    • 1
  • A. Branchereau
    • 2
  • P. Piquet
    • 3
  • M. Maurin
    • 4
  • D. Raoult
    • 1
  1. 1.Unité des Rickettsies, CNRS UMR 6020, IFR 48, Faculté de MédecineUniversité de la MéditerranéeMarseille Cedex 5France
  2. 2.Service de Chirurgie VasculaireHôpital de la TimoneMarseilleFrance
  3. 3.Service de Chirurgie VasculaireHôpital Sainte-MargueriteMarseilleFrance
  4. 4.Laboratoire de BactériologieHôpital MichallonGrenobleFrance

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