Q热心内膜炎四例并文献复习
Q fever endocarditis: a report of four cases and literature review
目的 加深对Q热心内膜炎的认识,提高临床诊疗水平.方法 对北京协和医院2008-2013年诊治的4例Q热心内膜炎的临床、实验室检查特点和治疗情况总结分析并进行文献复习.结果 4例患者均长期发热,体检有心脏杂音,2例有呼吸道症状,1例有非特异性皮疹.一般检查如血常规、ESR、C反应蛋白、肝功能、肺部影像学检查等无特异性改变,超声心动图均提示心内膜炎,多次血培养阴性.4例均经特异性抗体检测阳性确诊,并经多西环素或米诺环素等规范治疗,恢复良好.结论 心内膜炎是慢性Q热的主要表现形式,可以伴发肺炎和肝脏损害,临床表现多样、缺乏特异性,且血培养阴性,临床容易误诊漏诊.对长期发热,尤其血培养阴性的心内膜炎,应考虑到本病.血清抗体检测是确诊的主要手段.早期充分治疗可以改善预后.
更多Objective To improve the diagnosis and treatment of Q fever endocarditis.Methods From 2008 to 2013,four cases of Q fever endocarditis were diagnosed in Peking Union Medical College Hospital.Clinical features,laboratory test,management and prognosis were analyzed with literature review.Result All four cases had long period of fever and heart murmur.Two patients represented with respiratory symptom and one with non-specific rash.General laboratory tests including complete blood cell count,ESR,C-reactive protein(CRP),liver function and radiology of lung did not show specific abnormalities.Signs of endocarditis were shown by ultrasound and important for diagnosis.Repeated blood culture was negative.All of the diagnoses were confirmed by serum antibody detection and the patients recovered well with treatment based on doxycycline or minocycline.Conclusions Endocarditis is the most common form of chronic Q fever,which is easily misdiagnosed because its blood culture is negative and may accompanied with varied manifestation such as pneumonia and liver injury.For the patients with chronic fever and blood culture negative endocarditis,chronic Q fever should be considered as differential diagnosis.The confirmatory method for diagnosis is serum antibody detection.Early and sufficient treatment may improve the prognosis.
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