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复发慢性Q热病心内膜炎子在沙特阿拉伯-艾哈迈德。萨利姆沙特本阿卜杜勒阿齐兹国王大学

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简介:虽然在儿童慢性Q热是罕见的,到目前为止心内膜炎是最常见的慢性Q热的综合症。尤其当先前存在的先天性心脏病。这种情况下做目前的诊断和治疗的挑战。案例:我们现在复发慢性Q热的心内膜炎与右心室双出口纠正一个8岁的男孩通过Yasui(诺伍德/拉斯泰利)过程与右VenticlePulmonary动脉Contegra导管插入。20一个月后,他的病开始发热来历不明的脾肿大和心脏杂音。基于超声心动图诊断文化负面心内膜炎叠,他收到了6周的万古霉素和庆大霉素然后出院。发烧但是并没有完全解决。一个月后重新排除亚急性细菌性心内膜炎,万古霉素和经验开始,Ceftazedime、阿米卡星和利福平。诊断慢性Q热心内膜炎是由血清学和环丙沙星治疗开始,持续了两年。病人开发渠道狭窄。 During the time of therapy his Coxiella burnetii antibodies titers were rising, along with liver transaminitis and development of hepatomegaly. At that stage, we thought that this was because of the presence of infected pulmonary artery conduit (foreign material). The patient was referred to cardiac surgery again for removal of what we thought was the source of persistence of his high C. burnetii antibodies titers. The patient underwent open heart surgery and conduit replacement. We restarted him on Ciprofloxacin for another 3 years. We also added Rifampicin and increased the dose of Ciprofloxacin. But his titers were not going down as excepted, so we started him on Doxycycline as he was 8 years old, and discontinued Ciprofloxacin and Rifampicin. He responded well initially, but liver enzymes remained elevated. Therefore, we restarted Ciprofloxacin again in addition to the Doxycycline, which were effective in normalizing his liver enzymes, and had resolved hepatosplenomegaly. Unfortunately, the patient developed drug intolerance to Ciprofloxacin, so we had to switch it back to Rifampicin that was later discontinued as his liver enzymes were rising. On latest follow up, towards his ninth birthday, the patient again having rising C. burnetii antibodies titers. Discussion: The clinical course of chronic Q fever endocarditis can be slow and indolent in nature, some with relapses and treatment failure. Looking into the literature, up to 50% of the time, relapse can occur even with prolonged therapy. This is the first case of pediatric chronic Q fever endocarditis in our institution since its start up in 1982. Our patient initially received 2 years of antibiotic treatment for chronic Q fever endocarditis, and then continued for another 3 years. Currently he is on Doxycycline. Despite this, the patient still has relapse. So the question remains, for how long should we treat a patient post relapse?

艾哈迈德。萨利姆和阿拉m . Al-Juaid

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