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Q fever, caused by the rickettsia Coxiella burnetii, is a worldwide zoonotic disease with both acute and chronic manifestations. Endocarditis is the principal chronic manifestation. Q fever can easily be mistaken for degenerative valve disease due to its indolent presentation, the fastidious nature of the organism (routine cultures are negative), and the absence of a typical echocardiographic and macroscopic appearance for endocarditis. Prosthetic valve failure, with associated morbidity and mortality, have been described following unrecognized infections.Previous studies have documented the value of screening strategies in areas of high prevalence. Hence, a pilot study was conducted in a low-prevalence setting, in which 139 patients at two tertiary cardiac centers attending for elective valve replacement for degenerative valvular disease underwent testing for chronic Q fever infection by serological and molecular methods on blood and valve tissue.Five patients (3.7%) had serological evidence of past exposure to Q fever (consistent with rates in the literature). None had evidence of chronic Q fever endocarditis. The cost of adopting a universal screening strategy is around £40,000 per case (if serology is used to screen patients prior to surgery).Alternative and more cost-effective methods for identifying clinically quiet cases of chronic Q fever endocarditis are required.


Journal article


The Journal of heart valve disease

Publication Date





375 - 379


Public Health Wales, Cardiff, Wales, UK. Electronic correspondence:


Heart Valves, Humans, Coxiella burnetii, Endocarditis, Bacterial, Q Fever, Heart Valve Diseases, DNA, Bacterial, Serologic Tests, Heart Valve Prosthesis Implantation, Bacteriological Techniques, Prevalence, Seroepidemiologic Studies, Pilot Projects, Predictive Value of Tests, Polymerase Chain Reaction, Tertiary Care Centers, United Kingdom