Long term vascular complications of Coxiella burnetii infection in Switzerland: cohort study

Objective: To evaluate the range of long term vascular manifestations of Coxiella burnetii infection. Design: Cohort study in Switzerland of people affected in 1983 by the largest reported outbreak of Q fever and who were followed up 12 years later. Follow up information about possible vascular disease and endocarditis was obtained through a mailed questionnaire and death certificates. Setting: Val de Bagnes, a rural Alpine valley in Switzerland. Participants: 2044 (87%) of 2355 people who had serum testing for Coxiella burnetii infection in 1983: 1247 were classed as not having been infected, 411 were classed as having been acutely infected, and 386 were classed as having been infected before 1983. Main outcome measures: Relative risk controlled for age and sex and 12 year risk of vascular diseases and endocarditis among infected participants as compared with those who had never been infected. Results: The 12 year risk of endocarditis or venous thromboembolic disease was not increased among those who had been acutely infected The 12 year risk of arterial disease was significantly higher among those who had been acutely infected (7%) as compared with those who had never been infected (4%) (relative risk 2.2, 95% confidence interval 1.4 to 3.6). Specifically, there was an increased risk of developing a cerebrovascular accident (relative risk 3.7, 1.6 to 8.4) and cardiac ischaemia (relative risk 1.9, 1.04 to 3.4). 12 year mortality was significantly higher among the 411 people who had been acutely infected in 1983 (9.7%; age adjusted relative risk 1.8, 1.2 to 2.6) when compared with the 1247 participants who had remained serologically negative in 1983 (7.0%). Conclusions:Coxiella burnetii infection may cause long term complications including vascular disease. Key messages The risk of developing venous or arterial disease after infection with Coxiella burnetii was assessed in a Swiss cohort of 2044 people exposed to the largest reported outbreak of Q fever Twelve year mortality was significantly higher among people who had been acutely infected in 1983 The 12 year risk of arterial disease was significantly higher among those who had been acutely infected (7%) than among those who had not been infected (4%) Compared with those participants who tested negative, those who were acutely infected with C burnetii had an increased relative risk of having a cerebrovascular accident or cardiac ischaemia Infection with C burnetii may be responsible for the development of vascular diseases in addition to infection with Chlamydia pneumoniae, cytomegalovirus, and Helicobacter pylori