A fatal case of disseminated chronic Q fever: a case report and brief review of the literature

Infection. 2016 Oct;44(5):677-82. doi: 10.1007/s15010-016-0884-0. Epub 2016 Mar 3.

Abstract

Background: Chronic Q fever is a rare infection, which mainly manifests as endocarditis, infection of vascular prostheses or aortic aneurysms. We present the case of a 74-year-old immunocompromised man with a haematologically disseminated Coxiella burnetii infection, which has never been reported before.

Case report: He was diagnosed with a chronic Q fever infection of an aneurysm with an endovascular prosthesis in 2015, but he died despite optimal treatment. Autopsy revealed a disseminated C. burnetii infection, confirmed by a positive PCR on samples from several organs. Retrospectively, he already had complaints and signs of inflammation since 2012, for which he had already been admitted in February 2014. At that time, Q fever diagnostics using PCR, complement fixation assay, and enzyme-linked immunosorbent assay on serum were all negative. In retrospect however, retesting available samples from February 2014 using immunofluorescence assay (IFA) already revealed serology compatible with chronic Q fever.

Conclusion: Clinicians should be aware of this silent killer, especially in case of risk factors, and perform an appropriate diagnostic work-up for Q fever including IFA serology and PCR.

Keywords: Chronic Q fever; Coxiella burnetii; Disseminated infection; Fatal; Q fever.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Aged
  • Aortic Aneurysm, Abdominal / surgery
  • Blood Vessel Prosthesis / microbiology*
  • Chronic Disease
  • Complement Fixation Tests
  • Coxiella burnetii / isolation & purification*
  • Enzyme-Linked Immunosorbent Assay
  • Fatal Outcome
  • Fluorescent Antibody Technique
  • Humans
  • Male
  • Polymerase Chain Reaction
  • Q Fever / diagnosis*
  • Q Fever / drug therapy
  • Q Fever / microbiology
  • Risk Factors
  • Thoracic Surgical Procedures / adverse effects