{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T14:02:32Z","timestamp":1773842552590,"version":"3.50.1"},"reference-count":59,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2024,7,11]],"date-time":"2024-07-11T00:00:00Z","timestamp":1720656000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Polymicrobial endocarditis is uncommon, and polymicrobial endocarditis in combination with Coxiella burnetii is very rare. We herein describe an extremely rare case of polymicrobial bivalvular endocarditis due to coinfection with Enterococcus faecalis and Coxiella burnetii in a 62-year-old male patient, and extensively review the relevant medical literature. To the best of our knowledge, only three similar cases have been previously reported. Q fever is a worldwide endemic bacterial zoonosis, but it and its most common chronic complication, endocarditis, are still underestimated and underdiagnosed worldwide. This situation reflects the paucity of reported cases of polymicrobial endocarditis in combination with Coxiella burnetii. Clinical presentation of Q fever endocarditis is highly nonspecific, and diagnosis may be delayed or missed, leading to severe and potentially fatal disease. Our case and the previously reported similar cases emphasize the need for further evaluation of infective endocarditis due to Coxiella burnetii, in all cases of culture-negative endocarditis, and in prolonged oligo-symptomatic inflammatory syndrome, particularly in the presence of valvular heart disease. This approach should be applied even when typical pathogens are isolated, especially in endemic areas of Q fever, and with atypical presentation.<\/jats:p>","DOI":"10.3390\/medicina60071122","type":"journal-article","created":{"date-parts":[[2024,7,11]],"date-time":"2024-07-11T15:59:48Z","timestamp":1720713588000},"page":"1122","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Bivalvular Endocarditis Due to Polymicrobial Coinfection with Enterococcus faecalis and Coxiella burnetii: A Case Report and Review of the Literature"],"prefix":"10.3390","volume":"60","author":[{"given":"Asala","family":"Abu-Ahmad","sequence":"first","affiliation":[{"name":"Infectious Diseases Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3104802, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4353-9703","authenticated-orcid":false,"given":"Fadel","family":"Bahouth","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Bnai Zion Medical Center, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3104802, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mirit","family":"Hershman-Sarafov","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3104802, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alona","family":"Paz","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3104802, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Majed","family":"Odeh","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine A, Bnai Zion Medical Center, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3104802, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,7,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e2000","DOI":"10.1097\/MD.0000000000002000","article-title":"Polymicrobial infective endocarditis: Clinical features and prognosis","volume":"94","author":"Vilacosta","year":"2015","journal-title":"Medicine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.1086\/520304","article-title":"Native valve infective endocarditis in elderly and younger adult patients: Comparison of clinical features and outcomes with use of the Duke criteria and the Duke Endocarditis Database","volume":"26","author":"Gagliardi","year":"1998","journal-title":"Clin. 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