Heart transplantation for end-stage heart failure combined with Q fever isolated to the heart: a case report. Issue 6 (5th December 2020)

• Record Type: Journal Article
• Authors: van 't Veer, Marcel; Otterspoor, Luuk; de Regt, Marieke; Peels, Kathinka; evens, Jola; Vink, Aryan; de Jonge, Nicolaas
• Editors: Sylvia, Krupickova; Filippo, Puricelli; Alberto, Bouzas-Mosquera; Gemima, Doolub; Ross, Thomson
• Is Part Of: European heart journal. Volume 4:Issue 6(2020)
• Page Start: 1
• Page End: 4
• Publication Date: 2020-12-05
• Subjects: Heart transplantation -- Coxiella burnetii -- Q fever -- Endocarditis -- Heart failure -- Case report; Cardiology -- Periodicals; Cardiology -- Case studies -- Periodicals; Heart -- Diseases -- Periodicals; Heart -- Diseases -- Case studies -- Periodicals; 616.12
• DOI: 10.1093/ehjcr/ytaa435
• Languages: English
• ISSNs: 2514-2119

Abstract

Abstract: Background : Active infection is generally considered a contraindication for heart transplantation. The rare combination of a patient with an active Coxiella burnetii infection and a congenital corrected transposition of the great arteries requiring heart transplantation impose challenging treatment decisions. We would like to demonstrate that if Q fever is restricted to the heart only, heart transplantation is also beneficial from an infectious point of view, therefore treating two severe conditions simultaneously. Case summary : A patient with end-stage heart failure due to congenital corrected transposition of the great arteries and requiring heart transplantation developed chronic Q fever and endocarditis. Different antibiotic regimes were tried due to severe adverse reactions. Antibiotic treatment was precisely monitored by measuring Q fever polymerase chain reaction (PCRs) and phase I IgG antibody titres. A positron emission tomography scan revealed that Q fever was confined to the heart only after which it was decided to perform heart transplantation. Based on the results of PCR and antibody testing, antibiotic treatment was stopped after 1 year. After 5 years of follow-up, patient is still in an optimal condition. Discussion : In case of a patient with end-stage heart failure and chronic Q fever, a combined treatment with PCR-/antibody monitored antibiotics and heart transplantation can cure both conditions.