Clinical Features and Complications ofCoxiella burnetiiInfections From the French National Reference Center for Q Fever

Abstract

Key Points Question What are the characteristics and clinical presentations of Coxiella burnetii infection using 21st-century–clarified definitions? Finding In a cohort study of 2434 patients with Q fever, the following new critical Q fever foci were identified: acute endocarditis, lymphadenitis, and bone marrow involvement in hemophagocytic syndrome. Lymphadenitis is a risk factor for lymphoma, and the elevation of IgG anticardiolipin antibody titers in acute Q fever is associated with complications. Meaning Screening for anticardiolipin antibodies may help prevent acute Q fever complications; the use of transthoracic echocardiography in acute Q fever and positron emission tomographic scanning in suspected persistent focalized infection is justified to improve the care of patients with Q fever.

Severe acute Q fever pneumonia complicated by presumed persistent localized Q fever endocarditis in a renal transplant recipient: A case report and review of the literature

“…Even though persons with underlying immunosuppression are at increased risk for developing Q fever, there are few reported cases of Q fever in SOT recipients. In a recent cohort study evaluating over 2000 patients with Q fever from the French National Reference Center for Q fever from 1991 to 2016, only 14 patients had SOTs, most of which were renal transplants . Two‐thirds of patients who were classified as immunosuppressed experienced acute Q fever, though details of these patients are lacking.…”

Unusual presentation of Q fever in a kidney‐pancreas transplant recipient

“…SOT recipients comprised of only 14 (0.6%) patients (10 renal, 3 liver, and 1 heart transplant) among a large cohort of 2434 patients with Q fever over a 26‐year period from the French National Reference Center for Q fever. However, detailed information of these cases is not provided . Four other cases of Q fever in SOT recipients were recently reviewed by Petty et al One other reported case involved a simultaneous heart and kidney transplant recipient, where the diagnosis of Q fever endocarditis was missed before transplant leading to mitral and aortic valve regurgitation in the transplanted heart .…”

“…Our patient had chronic Q fever pneumonitis (or “persistent focal pneumonitis” as some experts prefer to call it) based on elevated phase I IgG (≥800). Unlike acute Q fever which is characterized by elevated phase II IgM and IgG and low or nonexistent phase I IgG, in chronic infection, there is a phase switch with phase I IgG titer being typically ≥800 (although in some chronic infections like lymphadenitis and chronic interstitial lung disease, the cutoff for phase I IgG can be lower, eg, ≥400) …”

“…Q fever has been rarely reported in SOT recipients . In a study of 84 cases of chronic Q fever in France, 17 (20%) patients were immunocompromised and only one of them was a transplant recipient .…”

“…Q fever caused by Coxiella burnetii has been rarely described in solid organ transplant (SOT) recipients . Here, we report an unusual presentation of Q fever in a kidney‐pancreas transplant recipient presenting as chronic granulomatous lung disease.…”