Chronic Q Fever with Vascular Involvement: Progressive Abdominal Pain in a Patient with Aortic Aneurysm Repair in the United States.

• Type of Material: Article
• Authors: Zanthia Wiley, Emory University; Sujan Reddy, Centers for Disease Control and Prevention; Kara M. Jacobs Slifka, Emory University; David Brandon, Emory University; John Jernigan, Emory University; Gilbert J. Kersh, Centers for Disease Control and Prevention; Paige A. Armstrong, Centers for Disease Control and Prevention
• Language: English
• Date: 2019-02-19
• Publisher: Hindawi
• Publication Version: Final Published Version
• Copyright Statement: © 2019 Zanthia Wiley et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1155/2019/5369707
• Title of Journal or Parent Work: Case Reports in Infectious Diseases
• ISSN: 2090-6625
• Volume: 2019
• Start Page: 5369707
• End Page: 5369707
• Keywords: risk factors; hydroxychloroquine; aneurysms; vascular involvement; weight loss; Coxiella burnetii; fatigue; endocarditis; vascular prostheses; surgery; mortality; Q fever; zoonotic disease; vascular surgery; abdominal pain; antibody detection; Chronic Q fever; doxycycline; valvular defects
• Research Categories: Biology, Virology; Health Sciences, Medicine and Surgery

Abstract

Q fever is a zoonotic bacterial infection caused by Coxiella burnetii. Chronic Q fever comprises less than five percent of all Q fever cases and, of those, endocarditis is the most common presentation (up to 78% of cases), followed by vascular involvement. Risk factors for chronic Q fever with vascular involvement include previous vascular surgery, preexisting valvular defects, aneurysms, and vascular prostheses. The most common symptoms of chronic Q fever with vascular involvement are nonspecific, including weight loss, fatigue, and abdominal pain. Criteria for diagnosis of chronic Q fever include clinical evidence of infection and laboratory criteria (antibody detection, detection of Coxiella burnetii DNA, or growth in culture). Treatment of chronic Q fever with vascular involvement includes a prolonged course of doxycycline and hydroxychloroquine (≥18 months) as well as early surgical intervention, which has been shown to improve survival. Mortality is high in untreated chronic Q fever. We report a case of chronic Q fever with vascular involvement in a 77-year-old man with prior infrarenal aortic aneurysm repair, who lived near a livestock farm in the southeastern United States.