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European Heart Journal 1986 7(12):1062-1066;
Copyright © 1986 by the European Society of Cardiology.
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© 1986 The European Society of Cardiology

Serological diagnosis of Q fever endocarditis

G. DUPUIS*,, O. PÉTER*, R. LÜTHY{dagger}, J. NICOLET{ddagger}, M. PEACOCK§ and W. BURGDORFER§

*Division of Clinical Microbiology and Infecions Diseases, Valais Central Intstitute Sion
{dagger}Division of Infections Diseases, University Hospital Zürich
{ddagger}Institute of Veterinary Bacteriology, University of Bern Bern, Switzerland
§Laboratory of Pathobiology, Rocky Mountain Laboratories, National Institute of Allergy and Infections Diseases Homilton, Montana, U.S.A.

accepted 6 May 1986.

Address for correspondence: G. Dupuis, Valais Central Institute, CH-1951 Sion 3/Switzerland.

Abstract

The diagnosis of Q fever endocarditis cannot be made by bacterial cultures and necessitates serological identification of specific antibodies to Coxiella burnetii which stimulates mainly the production of anti-phase II antibodies during the acute diséase, but primarily anti-phase I antibodies in endocarditis. Indirect micro-immunofluorescence allows rapid detection of specific IgA, IgG and IgM. The results of serological analyses of 191 acute cases of Q fever were compared with those of 8 cases of Coxiella burnetii endocarditis. All sera were evaluated by complement fixation and microimmunofluorescence tests. The highest titre differences between primary Q fever and Q fever endocarditis were observed with anti-phase IIgA and IgG antibodies measured by microimmunofluorescence followed by anti-phase I antibodies measured by complement fixation tests. Anti-phase IIgG and IgM titres were consistently higher than anti-phase II titres in endocarditis. The reverse is true in acute Q fever. In addition, anti-phase I Ig A appeared to be diagnostic for Coxiella burnetii endocarditis. Accordingly we recommend the testing of these specific IgA, IgG, and IgM by microimmunofluorescence in cases of culture-negative endocarditis. These tests could also prove useful for following the development of Coxiella burnetii endocarditis in patients under treatment.

Key Words: Q fever • Coxiella burnetti • rickettsial endocarditis


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