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Thrombosis and antiphospholipid antibody syndrome during acute Q fever: A cross-sectional study.

Abstract Q fever is a neglected and potentially fatal disease. During acute Q fever, antiphospholipid antibodies are very prevalent and have been associated with fever, thrombocytopenia, acquired heart valve disease, and progression to chronic endocarditis. However, thrombosis, the main clinical criterion of the 2006 updated classification of the antiphospholipid syndrome, has not been assessed in this context. To test whether thrombosis is associated with antiphospholipid antibodies and whether the criteria for antiphospholipid syndrome can be met in patients with acute Q fever, we conducted a cross-sectional study at the French National Referral Center for Q fever.Patients included were diagnosed with acute Q fever in our Center between January 2007 and December 2015. Each patient's history and clinical characteristics were recorded with a standardized questionnaire. Predictive factors associated with thrombosis were assessed using a rare events logistic regression model. IgG anticardiolipin antibodies (IgG aCL) assessed by an enzyme-linked immunosorbent assay were tested on the Q fever diagnostic serum. A dose-dependent relationship between IgG aCL levels and thrombosis was tested using a receiver operating characteristic (ROC) analysis.Of the 664 patients identified for inclusion in the study, 313 (47.1%) had positive IgG aCL and 13 (1.9%) were diagnosed with thrombosis. Three patients fulfilled the antiphospholipid syndrome criteria. After multiple adjustments, only positive IgG aCL (relative risk, 14.46 [1.85-113.14], P = .011) were independently associated with thrombosis. ROC analysis identified a dose-dependent relationship between IgG aCL levels and occurrence of thrombosis (area under curve, 0.83, 95%CI [0.73-0.93], P < .001).During acute Q fever, antiphospholipid antibodies are associated with thrombosis, thrombocytopenia, and acquired valvular heart disease. Antiphospholipid antibodies should be systematically assessed in acute Q fever patients. Hydroxychloroquine, which has been previously shown to antagonize IgG aCL pathogenic properties, should be tested in acute Q fever patients with anticardiolipin antibodies to prevent antiphospholipid-associated complications.Key Point: In addition to fever, thrombocytopenia and acquired valvular heart disease, antiphospholipid antibodies are associated with thrombosis during acute Q fever.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 28723794
OWN - NLM
STAT- MEDLINE
DA  - 20170720
DCOM- 20170808
LR  - 20170808
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 29
DP  - 2017 Jul
TI  - Thrombosis and antiphospholipid antibody syndrome during acute Q fever: A
      cross-sectional study.
PG  - e7578
LID - 10.1097/MD.0000000000007578 [doi]
AB  - Q fever is a neglected and potentially fatal disease. During acute Q fever,
      antiphospholipid antibodies are very prevalent and have been associated with
      fever, thrombocytopenia, acquired heart valve disease, and progression to chronic
      endocarditis. However, thrombosis, the main clinical criterion of the 2006
      updated classification of the antiphospholipid syndrome, has not been assessed in
      this context. To test whether thrombosis is associated with antiphospholipid
      antibodies and whether the criteria for antiphospholipid syndrome can be met in
      patients with acute Q fever, we conducted a cross-sectional study at the French
      National Referral Center for Q fever.Patients included were diagnosed with acute 
      Q fever in our Center between January 2007 and December 2015. Each patient's
      history and clinical characteristics were recorded with a standardized
      questionnaire. Predictive factors associated with thrombosis were assessed using 
      a rare events logistic regression model. IgG anticardiolipin antibodies (IgG aCL)
      assessed by an enzyme-linked immunosorbent assay were tested on the Q fever
      diagnostic serum. A dose-dependent relationship between IgG aCL levels and
      thrombosis was tested using a receiver operating characteristic (ROC) analysis.Of
      the 664 patients identified for inclusion in the study, 313 (47.1%) had positive 
      IgG aCL and 13 (1.9%) were diagnosed with thrombosis. Three patients fulfilled
      the antiphospholipid syndrome criteria. After multiple adjustments, only positive
      IgG aCL (relative risk, 14.46 [1.85-113.14], P = .011) were independently
      associated with thrombosis. ROC analysis identified a dose-dependent relationship
      between IgG aCL levels and occurrence of thrombosis (area under curve, 0.83,
      95%CI [0.73-0.93], P &lt; .001).During acute Q fever, antiphospholipid antibodies
      are associated with thrombosis, thrombocytopenia, and acquired valvular heart
      disease. Antiphospholipid antibodies should be systematically assessed in acute Q
      fever patients. Hydroxychloroquine, which has been previously shown to antagonize
      IgG aCL pathogenic properties, should be tested in acute Q fever patients with
      anticardiolipin antibodies to prevent antiphospholipid-associated
      complications.Key Point: In addition to fever, thrombocytopenia and acquired
      valvular heart disease, antiphospholipid antibodies are associated with
      thrombosis during acute Q fever.
FAU - Million, Matthieu
AU  - Million M
AD  - aURMITE, Aix Marseille Universite, UM63, CNRS 7278, IRD 198, INSERM 1095, IHU -
      Mediterranee Infection bAix Marseille Univ, APHM, INSERM, VRCM, UMR_S 1076,
      Laboratoire d'Immunologie, Marseille cService de medecine interne dService de
      maladies infectieuses, Centre Hospitalier Universitaire de Grenoble, Grenoble
      eService de medecine interne, Centre hospitalier d'Avignon, Avignon fService de
      medecine interne et tropicale, Hopital d'Instruction des Armees Laveran,
      Marseille gService de neurologie, Hopital de Valence, Valence hService de
      maladies infectieuses, Hopital Bretonneau, Tours iCentre Hospitalier
      Universitaire de Nice, Nice jService de medecine interne et maladies
      infectieuses, CHU de Poitiers, Inserm, Poitiers kService de maladies
      infectieuses, CHU de Montpellier, Montpellier lCentre Hospitalier Andree-Rosemon,
      Cayenne, Guyane mAix Marseille Univ, INSERM, UMR912 (SESSTIM), IRD nORS PACA
      oLaboratoire d'Hematologie, CHU Timone, APHM, Marseille, France.
FAU - Bardin, Nathalie
AU  - Bardin N
FAU - Bessis, Simon
AU  - Bessis S
FAU - Nouiakh, Nadia
AU  - Nouiakh N
FAU - Douliery, Charlaine
AU  - Douliery C
FAU - Edouard, Sophie
AU  - Edouard S
FAU - Angelakis, Emmanouil
AU  - Angelakis E
FAU - Bosseray, Annick
AU  - Bosseray A
FAU - Epaulard, Olivier
AU  - Epaulard O
FAU - Branger, Stephanie
AU  - Branger S
FAU - Chaudier, Bernard
AU  - Chaudier B
FAU - Blanc-Laserre, Karine
AU  - Blanc-Laserre K
FAU - Ferreira-Maldent, Nicole
AU  - Ferreira-Maldent N
FAU - Demonchy, Elisa
AU  - Demonchy E
FAU - Roblot, France
AU  - Roblot F
FAU - Reynes, Jacques
AU  - Reynes J
FAU - Djossou, Felix
AU  - Djossou F
FAU - Protopopescu, Camelia
AU  - Protopopescu C
FAU - Carrieri, Patrizia
AU  - Carrieri P
FAU - Camoin-Jau, Laurence
AU  - Camoin-Jau L
FAU - Mege, Jean-Louis
AU  - Mege JL
FAU - Raoult, Didier
AU  - Raoult D
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Antibodies, Anticardiolipin)
RN  - 0 (Immunoglobulin G)
SB  - AIM
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Antibodies, Anticardiolipin/blood
MH  - Antiphospholipid Syndrome/blood/*complications/drug therapy/immunology
MH  - Child
MH  - Cross-Sectional Studies
MH  - Enzyme-Linked Immunosorbent Assay
MH  - Female
MH  - Follow-Up Studies
MH  - France
MH  - Humans
MH  - Immunoglobulin G/blood
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Q Fever/blood/*complications/drug therapy/immunology
MH  - ROC Curve
MH  - Surveys and Questionnaires
MH  - Thrombosis/blood/*complications/drug therapy/immunology
MH  - Young Adult
PMC - PMC5521934
EDAT- 2017/07/21 06:00
MHDA- 2017/08/09 06:00
CRDT- 2017/07/21 06:00
AID - 10.1097/MD.0000000000007578 [doi]
AID - 00005792-201707210-00059 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Jul;96(29):e7578. doi: 10.1097/MD.0000000000007578.