Pediatric Q Fever Endocarditis in the Gulf Region: case series and Systematic Review

Background Pediatric Q fever endocarditis (PQFE) is a rare but serious infection caused by Coxiella burnetii . Diagnosis is often challenging due to nonspecific symptoms and the difficulty in culturing the bacteria. Objectives To describe epidemiological, clinical, and outcome data of PQFE in the Gulf Cooperation Countries (GCC). Methods It is a retrospective, descriptive study; data from patients admitted to a tertiary hospital in Saudi Arabia over the past 5 years were analyzed, supplemented by a review of all published PQFE cases in the GCC. Results Eighteen cases of chronic Q fever endocarditis in the GCC were identified. Three of these cases, comprising our series, occurred within the last 5 years, while the remaining fifteen were previously reported. The majority of cases originated in Saudi Arabia and were associated with a history of cardiac surgery for congenital heart malformations. Clinical presentation was typically atypical, characterized by fever, anemia, and hepatosplenomegaly. Diagnosis in all cases relied on serology, with a mean diagnostic delay of 8.3 months. Despite most patients receiving appropriate treatment with doxycycline and hydroxychloroquine, five required cardiac surgery, two experienced relapses, and one patient died. Conclusion PQFE is a rare disease with a significant diagnostic delay. Increased awareness among physicians, particularly pediatricians and cardiologists, is crucial for timely diagnosis and improved patient outcomes.