Long term vascular complications of Coxiella burnetii infection in Switzerland: cohort study

BMJ 1999;319:284-286 ( 31 July )

Papers

Long term vascular complications of Coxiella burnetii infection in Switzerland: cohort study

Pierre-Yves Lovey, senior resident, ^a Alfredo Morabia, director, ^b D Bleed, epidemiologist, ^b O Péter, bacteriologist, ^c G Dupuis, surgeon general, ^d J Petite, director. ^e

^a Department of Internal Medicine, University Hospital of Geneva, Rue Micheli du Crest 24, 1211 Geneva 14, Switzerland, ^b Division of Clinical Epidemiology, University Hospital of Geneva, ^c Division of Infectious Diseases and Immunology, Institut Central des Hôpitaux Valaisans, 1951 Sion, Switzerland, ^d Etat du Valais, 1950 Sion, Switzerland, ^e Service de Médecine Interne, Hôpital Régional, 1920 Martigny, Switzerland

Correspondence to: Dr Lovey Pierre-Yves.Lovey{at}hcuge.ch

Objective: To evaluate the range of long term vascularmanifestations of Coxiella burnetiiinfection.
Design: Cohort study in Switzerland of people affectedin 1983 by the largest reported outbreak of Q fever and who werefollowed up 12 years later. Follow up information about possiblevascular disease and endocarditis was obtained through a mailedquestionnaire and deathcertificates.
Setting: Val de Bagnes, a rural Alpine valley inSwitzerland.
Participants: 2044 (87%) of 2355 people who had serum testingfor Coxiella burnetii infection in 1983: 1247 were classed asnot having been infected, 411 were classed as having been acutelyinfected, and 386 were classed as having been infected before1983.
Main outcome measures: Relative risk controlled for age and sex and12 year risk of vascular diseases and endocarditis among infectedparticipants as compared with those who had never beeninfected.
Results: The 12 year risk of endocarditis or venousthromboembolic disease was not increased among those who had beenacutely infected. The 12 year risk of arterial disease was significantlyhigher among those who had been acutely infected (7%) as comparedwith those who had never been infected (4%) (relative risk 2.2,95% confidence interval 1.4 to 3.6). Specifically, there was anincreased risk of developing a cerebrovascular accident (relativerisk 3.7, 1.6 to 8.4) and cardiac ischaemia (relative risk 1.9,1.04 to 3.4). 12 year mortality was significantly higher amongthe 411 people who had been acutely infected in 1983 (9.7%; ageadjusted relative risk 1.8, 1.2 to 2.6) when compared with the1247 participants who had remained serologically negative in 1983(7.0%).
Conclusions: Coxiella burnetii infection may cause longterm complications including vasculardisease.

Key messages

The risk of developing venous or arterial disease after infection with Coxiella burnetii was assessed in a Swiss cohort of 2044 people exposed to the largest reported outbreak of Q fever
Twelve year mortality was significantly higher among people who had been acutely infected in 1983
The 12 year risk of arterial disease was significantly higher among those who had been acutely infected (7%) than among those who had not been infected (4%)
Compared with those participants who tested negative, those who were acutely infected with C burnetii had an increased relative risk of having a cerebrovascular accident or cardiac ischaemia
Infection with C burnetii may be responsible for the development of vascular diseases in addition to infection with Chlamydia pneumoniae, cytomegalovirus, and Helicobacter pylori

© BMJ 1999

CiteULike

Complore

Connotea

Del.icio.us Add to Digg

Digg

Technorati What's this?

Relevant Articles

Long term vascular complications of Coxiella burnetii infection: Martin Wildman, Jon G Ayres, Pierre-Yves Lovey, and Alfredo Morabia
BMJ 2000 320: 58. [Extract] [Full Text]

Coxiella burnetii infection may be linked to cardiovascular disease BMJ 1999 319: 0. [Full Text]

This article has been cited by other articles:

Baddour, L. M., Zheng, Z.-J., Labarthe, D. R., O'Connor, S. (2007). Task Force I: Direct Cardiovascular Implications of Emerging Infectious Diseases and Biological Terrorism Threats. J Am Coll Cardiol 49: 1380-1389 [Full text]
Ngeh, J., Goodbourn, C. (2005). Coxiella burnetii and Atypical Respiratory Infectious Burden in Stroke. Stroke 36: 1356-1356 [Full text]
Seshadri, R., Paulsen, I. T., Eisen, J. A., Read, T. D., Nelson, K. E., Nelson, W. C., Ward, N. L., Tettelin, H., Davidsen, T. M., Beanan, M. J., Deboy, R. T., Daugherty, S. C., Brinkac, L. M., Madupu, R., Dodson, R. J., Khouri, H. M., Lee, K. H., Carty, H. A., Scanlan, D., Heinzen, R. A., Thompson, H. A., Samuel, J. E., Fraser, C. M., Heidelberg, J. F. (2003). Complete genome sequence of the Q-fever pathogen Coxiellaburnetii. Proc. Natl. Acad. Sci. USA 100: 5455-5460 [Abstract] [Full text]
Raoult, D. (2002). Q fever: still a mysterious disease. QJM 95: 491-492 [Full text]
AYRES, J.G., WILDMAN, M., GROVES, J., MENT, J., SMITH, E.G., BEATTIE, J. M. (2002). Long-term follow-up of patients from the 1989 Q fever outbreak: no evidence of excess cardiac disease in those with fatigue. QJM 95: 539-546 [Abstract] [Full text]
Bellamy, R.J., Freedman, A.R. (2001). Bioterrorism. QJM 94: 227-234 [Full text]
Wildman, M., Ayres, J. G, Lovey, P.-Y., Morabia, A. (2000). Long term vascular complications of Coxiella burnetii infection. BMJ 320: 58a-58 [Full text]
(1999). Another Suspect in Vascular Disease: Coxiella burnetii. JWatch Infect. Diseases 1999: 10-10 [Full text]

Rapid Responses:

Read all Rapid Responses

Cardiovascular risk factors cannot be ignored in vascular disease following C burnetii infection.: Martin Wildman
bmj.com, 16 Aug 1999 [Full text]
C burnetii is different from Rickettsia spp.: Lars Wesslen
bmj.com, 27 Aug 1999 [Full text]