Discussion
Q fever, a zoonotic infectious disease, can present with chronic
manifestations rather than intermittent fever. The most common chronic
complication is endocarditis with a high rate of morbidity and
mortality. In addition to endocarditis, osteomyelitis is another chronic
Q fever complication [16-18]. C. burnetii grows on the
abnormal cardiac valve along with the prosthetic valve and causes Q
fever non-specific manifestations, therefore chronic Q fever is hardly
diagnosed and because of several antimicrobial treatment resistance, it
is hardly treated too. One of the risk factors for chronic Q fever is
valvular surgeries which our patient underwent several times [19,
20].
Due to the high prevalence of C. burnetii in our country, we
should consider it as an important agent for BCNE [21, 22].
Despite the great medical development, infective endocarditis is still a
concern in both diagnosis and treatment and the best option for early
diagnosis and immediate treatment is to consider IE as a possible
diagnosis [23, 24]. Even nowadays the mortality rate caused by IE
reaches 30% annually [25]. Echocardiography is a non-invasive
diagnostic evaluation in IE which can detect the vegetation accurately
without a significant difference from the surgical view. In some cases
like ours, there is no evidence suggesting IE in echocardiography,
therefore normal ECG cannot rule out IE diagnosis [26].
To identify extra cardiac IE manifestations, classification, and also
management, PET/CT scan is helpful. In our patient all the studies
except PET/CT scan couldn’t reveal the IE evidence, therefore we should
declare that performing PET/CT scan is a necessary evaluation in IE
cases or even in those with suspicious IE diagnosis [27, 28].