scholarly journals Chronic Q fever: An ongoing challenge in diagnosis and management

2014 ◽  
Vol 25 (1) ◽  
pp. 35-37 ◽  
Author(s):  
Ira Das ◽  
Nicola Guest ◽  
Richard Steeds ◽  
Peter Hewins
Keyword(s):  
Q Fever ◽  
Phase 1 ◽  
Laboratory Diagnosis ◽  
Serological Response ◽  
Diagnosis And Management ◽  
Duke Criteria ◽  
Chronic Q Fever ◽  
History Of ◽  
Level 1 ◽  
High Level

Chronic Q fever is a potentially fatal disease. The current difficulty in the diagnosis of this condition is discussed in the present article. A 51-year-old woman with a history of aortic valve replacement presented with complaints of feeling generally unwell, pyrexia and occasional unproductive cough over a period of several weeks. Phase 1 immunoglobulin G titre toCoxiella burnetiiwas initially detected at a low level (1:320, detected using immunofluorescence) and was not considered to be significant according to the modified Duke criteria. Later in the course of her illness, the patient’s antibody titre rose to a high level (1:1280). The issues regarding current laboratory diagnosis and management of Q fever are discussed. Chronic Q fever can be associated with an inadequate serological response. Close follow-up of cases is essential. The recommended serological criteria for the diagnosis of Q fever endocarditis needs to be revisited.

scholarly journals Assessment of Coxiella burnetii presence after tick bite in north-eastern Poland

Infection ◽  
2019 ◽  
Vol 48 (1) ◽  
pp. 85-90
Author(s):  
Karol Borawski ◽  
Justyna Dunaj ◽  
Piotr Czupryna ◽  
Sławomir Pancewicz ◽  
Renata Świerzbińska ◽  
...  
Keyword(s):  
Coxiella Burnetii ◽  
Blood Donors ◽  
Q Fever ◽  
Phase 1 ◽  
Molecular Study ◽  
Tick Bite ◽  
Control Group ◽  
Tick Borne Encephalitis ◽  
North Eastern ◽  
History Of

Abstract Purpose The aim of the study is to assess anti-Coxiella burnetii antibodies presence in inhabitants of north-eastern Poland, to assess the risk of Q fever after tick bite and to assess the percentage of co-infection with other pathogens. Methods The serological study included 164 foresters and farmers with a history of tick bite. The molecular study included 540 patients, hospitalized because of various symptoms after tick bite. The control group consisted of 20 honorary blood donors. Anti-Coxiella burnetii antibodies titers were determined by Coxiella burnetii (Q fever) Phase 1 IgG ELISA (DRG International Inc. USA). PCR was performed to detect DNA of C. burnetii, Borrelia burgdorferi and Anaplasma phagocytophilum. Results Anti-C. burnetii IgG was detected in six foresters (7.3%). All foresters with the anti-C. burnetii IgG presence were positive toward anti-B. burgdorferi IgG and anti-TBE (tick-borne encephalitis). Anti-C. burnetii IgG was detected in five farmers (6%). Four farmers with anti-C. burnetii IgG presence were positive toward anti-B. burgdorferi IgG and two with anti-TBE. Among them one was co-infected with B. burgdorferi and TBEV. Correlations between anti-C. burnetii IgG and anti-B. burgdorferi IgG presence and between anti-C. burnetii IgG presence and symptoms of Lyme disease were observed. C. burnetii DNA was not detected in any of the 540 (0%) patients. Conclusions C. burnetii is rarely transmitted by ticks, but we proved that it is present in the environment, so it may be a danger to humans. The most common co-occurrence after tick bite concerns C. burnetii and B. burgdorferi.

Successful treatment with azathioprine of relapsing Rosai-Dorfman disease of the central nervous system

2012 ◽  
Vol 117 (3) ◽  
pp. 486-489 ◽  
Author(s):  
Guillaume Le Guenno ◽  
Lionel Galicier ◽  
Emmanuelle Uro-Coste ◽  
Virginie Petitcolin ◽  
Virginie Rieu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Crohn Disease ◽  
Q Fever ◽  
Negative Results ◽  
Chronic Q Fever ◽  
Rosai Dorfman Disease ◽  
Purine Analog ◽  
History Of ◽  
The Central Nervous System

Rosai-Dorfman disease (RDD) is a rare non-Langerhans histiocytosis that usually presents with lymphadenopathy. Although isolated involvement of the CNS was considered to be uncommon, numerous cases have been reported in recent years. For RDD of the CNS, the treatment consists, in general, of surgery. In cases of partial resection or relapse, chemotherapy regimens, corticosteroids, and/or radiotherapy have yielded negative results. The authors describe the case of a 57-year-old man with a history of chronic Q fever who presented with aphasia and partial seizure. Computed tomography of the brain revealed a left frontotemporal lesion that was suggestive of a meningioma. The lesion was partially resected and histopathological evaluation revealed the presence of RDD. Nineteen months later, a Jacksonian seizure prompted MRI evaluation, which disclosed a local recurrence of the tumor. Computed tomography and FDG-PET demonstrated that the RDD involved no other site, but the presence of ileitis, noted on ileoscopy, led to the diagnosis of Crohn disease. Treatment with the purine analog azathioprine was initiated, leading to an objective and sustained response in both the RDD tumor and ileitis over 35 months of follow-up. This case report highlights the potential use of a purine analog in cases of relapsing RDD of the CNS and a possible common defect of macrophage regulation in RDD, Crohn disease, and Q fever.

scholarly journals Q Fever Endocarditis in Iran

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Pardis Moradnejad ◽  
Saber Esmaeili ◽  
Majid Maleki ◽  
Anita Sadeghpour ◽  
Monireh Kamali ◽  
...  
Keyword(s):  
Q Fever ◽  
Molecular Evidence ◽  
Tissue Samples ◽  
Duke Criteria ◽  
Chronic Q Fever ◽  
High Prevalence ◽  
The Mean ◽  
Polymerase Chain ◽  
Criteria For Diagnosis ◽  
Culture Negative

Abstract Patients with the underlying valvular heart disease are at the high risk of developing sub-acute or chronic endocarditis secondary to Coxiella burnetii. Q fever endocarditis is the most common manifestation along with persistent the infection. There is some serologic and molecular evidence of C. burnetii infection in humans and livestock in Iran. As it is possible to observe chronic Q fever in Iran, it seems necessary to study the prevalence of Q fever endocarditis in this country. In the present study, Infective Endocarditis (IE) patients (possible or definite based on Duke Criteria) hospitalized in Rajaie Cardiovascular Medical and Research Center were enrolled from August 2016 to September 2018. Culture-negative endocarditis patients were evaluated by Raoult criteria for diagnosis Q fever endocarditis. The serological results for brucellosis were negative for all subjects. All blood and tissue samples including valve samples were tested for C. burnetii infection using serology and Polymerase Chain Reaction (PCR). In this study, 126 patients who were admitted to the hospital were enrolled; of which 52 subjects were culture-negative IE. Among the participants, 16 patients (30.77%) were diagnosed with Q fever IE and underwent medical treatment. The mean age of patients was 46.6 years ranging from 23 to 69 years and 75% of them were male. Considering the high prevalence of Q fever IE, evaluation of the patients with culture-negative IE for C. burnetii infections was highly recommended.

Difficulties in the diagnosis and management of a US servicemember presenting with possible chronic Q fever

2010 ◽  
Vol 60 (2) ◽  
pp. 175-177 ◽  
Author(s):  
Julie A. Ake ◽  
Robert F. Massung ◽  
Timothy J. Whitman ◽  
Todd D. Gleeson
Keyword(s):  
Q Fever ◽  
Diagnosis And Management ◽  
Chronic Q Fever

scholarly journals Q Fever Endocarditis in Northeast Iran

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
Ali Akbar Heydari ◽  
Ehsan Mostafavi ◽  
Masoumeh Heidari ◽  
Mina Latifian ◽  
Saber Esmaeili
Keyword(s):  
Weight Loss ◽  
Q Fever ◽  
Igg Antibodies ◽  
Duke Criteria ◽  
Chronic Q Fever ◽  
Indirect Immunofluorescent Assay ◽  
Male Farmer ◽  
Indirect Immunofluorescent ◽  
Northeast Iran ◽  
Phase I And Ii

This report presents a case of chronic Q fever endocarditis. A 60-year-old male farmer and rancher was admitted to the hospital with symptoms of weight loss, fever, severe sweating, weakness, and anorexia. PCR was negative for C. burnetii in the blood sample, but phase I and II IgG antibodies against C. burnetii were positive (1 : 16384 and 1 : 2048, respectively) by the indirect immunofluorescent assay (IFA). According to the adjusted Duke criteria, Q fever endocarditis was confirmed, and the patient was successfully treated with doxycycline and hydroxychloroquine.

scholarly journals Q Fever

1999 ◽  
Vol 12 (4) ◽  
pp. 518-553 ◽  
Author(s):  
M. Maurin ◽  
D. Raoult
Keyword(s):  
Q Fever ◽  
Febrile Illness ◽  
Protective Role ◽  
Immunoglobulin M ◽  
Worldwide Distribution ◽  
Cell Extracts ◽  
Chronic Q Fever ◽  
Acute Q Fever ◽  
High Level ◽  
Immunocompromised Hosts

SUMMARY Q fever is a zoonosis with a worldwide distribution with the exception of New Zealand. The disease is caused by Coxiella burnetii, a strictly intracellular, gram-negative bacterium. Many species of mammals, birds, and ticks are reservoirs of C. burnetii in nature. C. burnetii infection is most often latent in animals, with persistent shedding of bacteria into the environment. However, in females intermittent high-level shedding occurs at the time of parturition, with millions of bacteria being released per gram of placenta. Humans are usually infected by contaminated aerosols from domestic animals, particularly after contact with parturient females and their birth products. Although often asymptomatic, Q fever may manifest in humans as an acute disease (mainly as a self-limited febrile illness, pneumonia, or hepatitis) or as a chronic disease (mainly endocarditis), especially in patients with previous valvulopathy and to a lesser extent in immunocompromised hosts and in pregnant women. Specific diagnosis of Q fever remains based upon serology. Immunoglobulin M (IgM) and IgG antiphase II antibodies are detected 2 to 3 weeks after infection with C. burnetii, whereas the presence of IgG antiphase I C. burnetii antibodies at titers of ≥1:800 by microimmunofluorescence is indicative of chronic Q fever. The tetracyclines are still considered the mainstay of antibiotic therapy of acute Q fever, whereas antibiotic combinations administered over prolonged periods are necessary to prevent relapses in Q fever endocarditis patients. Although the protective role of Q fever vaccination with whole-cell extracts has been established, the population which should be primarily vaccinated remains to be clearly identified. Vaccination should probably be considered in the population at high risk for Q fever endocarditis.

scholarly journals Chronic Q Fever in Alberta: A Case ofCoxiella burnetiiMycotic Aneurysm and Concomitant Vertebral Osteomyelitis

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
William Stokes ◽  
Jack Janvier ◽  
Stephen Vaughan
Keyword(s):  
Coxiella Burnetii ◽  
Vascular Tissue ◽  
Open Repair ◽  
Q Fever ◽  
Vertebral Osteomyelitis ◽  
Abdominal Aortic ◽  
Chronic Q Fever ◽  
Life Threatening ◽  
History Of ◽  
Polymerase Chain

Chronic Q fever is a potentially life-threatening infection from the intracellular, Gram-negativeCoxiella burnetii. It presents most commonly as endocarditis or vascular infection in people with underlying cardiac or vascular disease. We discuss a case of a 67-year-old male withCoxiella burnetiivascular infection of a perirenal abdominal aortic graft. The patient had a history of an abdominal aortic aneurysm (AAA) repair 5 years earlier. He presented with a 12 × 6 × 8 cm perirenal pseudoaneurysm and concomitant L1, L2, and L3 vertebral body discitis. He underwent an open repair which revealed a grossly infected graft perioperatively. Q fever serology revealed phase I serological IgG titer of 1 : 2048 and phase II 1 : 1024 consistent with chronic Q fever. Polymerase chain reaction (PCR) on infected vascular tissue was positive forC. burnetii. The patient was started on doxycycline and hydroxychloroquine with good clinical response and decreasing serological titers. Recognizing chronic Q fever is a difficult task as symptoms are nonspecific, exposure risk is difficult to ascertain, and diagnosis is hidden from conventional microbiological investigations. Its recognition, however, is critical asC. burnetiiis inherently resistant to standard empiric therapies used in cardiovascular infections.

scholarly journals A Case of Primary Aortoduodenal Fistula and Abdominal Aortic Aneurysm in a Patient with Chronic Q Fever

Aorta ◽  
2017 ◽  
Vol 05 (01) ◽  
pp. 27-29
Author(s):  
Arne de Niet ◽  
Ignace Tielliu ◽  
Paul van Schaik ◽  
Jan van den Dungen ◽  
Clark Zeebregts
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Medical Treatment ◽  
Causative Agent ◽  
Q Fever ◽  
Aortoduodenal Fistula ◽  
Abdominal Aortic ◽  
Chronic Q Fever ◽  
History Of

AbstractA 70-year-old man was successfully treated for an aortoduodenal fistula originating from a Q fever-related abdominal aortic aneurysm. He had no known history of contact with cattle or sheep. Although the combination of abdominal aortic aneurysm and aortoduodenal fistula is rare, one should be suspicious of Q fever infection as the causative agent, and additional medical treatment should be initiated.

scholarly journals Epidemiological investigation and physician awareness regarding the diagnosis and management of Q fever in South Korea, 2011 to 2017

2021 ◽  
Vol 15 (6) ◽  
pp. e0009467
Author(s):  
Yong Chan Kim ◽  
Hye Won Jeong ◽  
Dong-Min Kim ◽  
Kyungmin Huh ◽  
Sang-Ho Choi ◽  
...  
Keyword(s):  
South Korea ◽  
Online Survey ◽  
Q Fever ◽  
Management Strategies ◽  
Febrile Illness ◽  
Clinical Severity ◽  
Diagnosis And Management ◽  
Chronic Q Fever ◽  
Physician Awareness ◽  
Acute Q Fever

Background In South Korea, the number of Q fever cases has rapidly increased since 2015. Therefore, this study aimed to characterize the epidemiological and clinical features of Q fever in South Korea between 2011 and 2017. Methods/Principal findings We analyzed the epidemiological investigations and reviewed the medical records from all hospitals that had reported at least one case of Q fever from 2011 to 2017. We also conducted an online survey to investigate physicians’ awareness regarding how to appropriately diagnose and manage Q fever. The nationwide incidence rate of Q fever was annually 0.07 cases per 100,000 persons annually. However, there has been a sharp increase in its incidence, reaching up to 0.19 cases per 100,000 persons in 2017. Q fever sporadically occurred across the country, with the highest incidences in Chungbuk (0.53 cases per 100,000 persons per year) and Chungnam (0.27 cases per 100,000 persons per year) areas. Patients with acute Q fever primarily presented with mild illnesses such as hepatitis (64.5%) and isolated febrile illness (24.0%), whereas those with chronic Q fever were likely to undergo surgery (41.2%) and had a high mortality rate (23.5%). Follow-up for 6 months after acute Q fever was performed by 24.0% of the physician respondents, and only 22.3% of them reported that clinical and serological evaluations were required after acute Q fever diagnosis. Conclusions Q fever is becoming an endemic disease in the midwestern area of South Korea. Given the clinical severity and mortality of chronic Q fever, physicians should be made aware of appropriate diagnosis and management strategies for Q fever.

scholarly journals Prevalence of Chronic Q Fever in Patients with a History of Cardiac Valve Surgery in an Area Where Coxiella burnetii Is Epidemic

2012 ◽  
Vol 19 (8) ◽  
pp. 1165-1169 ◽  
Author(s):  
Linda M. Kampschreur ◽  
Jan Jelrik Oosterheert ◽  
Andy I. M. Hoepelman ◽  
Peter J. Lestrade ◽  
Nicole H. M. Renders ◽  
...  
Keyword(s):  
High Risk ◽  
Phase I ◽  
Q Fever ◽  
Risk Groups ◽  
Valve Surgery ◽  
Cardiac Valve ◽  
Content Type ◽  
Cardiac Valve Surgery ◽  
Chronic Q Fever ◽  
History Of

ABSTRACTChronic Q fever develops in 1 to 5% of patients infected withCoxiella burnetii. The risk for chronic Q fever endocarditis has been estimated to be ∼39% in case of preexisting valvulopathy and is potentially even higher for valvular prostheses. Since 2007, The Netherlands has faced the largest Q fever outbreak ever reported, allowing a more precise risk estimate of chronic Q fever in high-risk groups. Patients with a history of cardiac valve surgery were selected for microbiological screening through a cardiology outpatient clinic in the area where Q fever is epidemic. Blood samples were analyzed for phase I and II IgG againstC. burnetii, and if titers were above a defined cutoff level,C. burnetiiPCR was performed. Chronic Q fever was considered proven ifC. burnetiiPCR was positive and probable if the phase I IgG titer was ≥1:1,024. Among 568 patients, the seroprevalence ofC. burnetiiantibodies (IgG titer greater than or equal to 1:32) was 20.4% (n= 116). Proven or probable chronic Q fever was identified among 7.8% of seropositive patients (n= 9). Valve characteristics did not influence the risk for chronic Q fever. Patients with chronic Q fever were significantly older than patients with past Q fever. In conclusion, screening of high-risk groups is a proper instrument for early detection of chronic Q fever cases. The estimated prevalence of chronic Q fever is 7.8% among seropositive patients with a history of cardiac valve surgery, which is substantially higher than that in nonselected populations but lower than that previously reported. Older age seems to increase vulnerability to chronic Q fever in this population.

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