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

Stephan P Keijmel,Teske Schoffelen,Maria C W Salet,Ruud P H Raijmakers,Chantal P Bleeker-Rovers

doi:10.1007/s15010-016-0884-0

Stephan P Keijmel, Teske Schoffelen + Show 3 more

Open Access

https://doi.org/10.1007/s15010-016-0884-0

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Abstract

BackgroundChronic 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.

Highlights

Following primary infection with Coxiella burnetii, an intracellular Gram-negative coccobacillus, 1–5 % of patients develop chronic Q fever, which is characterized by the persistence of C. burnetii
We report a fatal case of a disseminated chronic Q fever infection, confirmed by positive PCR for C. burnetii on lung tissue, an endovascular aneurysm repair (EVAR) specimen, a psoas abscess specimen, and ascites from the abdominal right lower quadrant
We describe an immunocompromised patient with a widely disseminated chronic Q fever infection with infectious foci in the EVAR and surrounding abdominal aortic aneurysm (AAA), both lungs, iliopsoas muscle, spine, spleen, and in ascites from the abdominal right lower quadrant

Summary

Introduction

Following primary infection with Coxiella burnetii, an intracellular Gram-negative coccobacillus, 1–5 % of patients develop chronic Q fever, which is characterized by the persistence of C. burnetii. We report a fatal case of a disseminated chronic Q fever infection, confirmed by positive PCR for C. burnetii on lung tissue, an endovascular aneurysm repair (EVAR) specimen, a psoas abscess specimen, and ascites from the abdominal right lower quadrant. 18F-fluorodeoxyglucose positron emission tomography/low-dose CT (18FDG-PET/ CT) 3 days later showed a normal FDG distribution in the patients’ head, neck, and brain parenchyma, but a high pulmonary FDG-uptake suggestive for pneumonia, and signs of an infected AAA expanding to the left psoas muscle. Despite several drains in the multiloculated abscess, CRP increased to 261 mg/l and he developed a fever His hospital stay was complicated by two episodes of presumed hospital-acquired pneumonia (for which he received piperacillin/tazobactam), acute decompensated heart failure, respiratory failure presumably due to an aspiration pneumonia, and sepsis, for which he was temporarily transferred to the intensive care unit twice. The 18FDG-PET could not be assessed for disseminated lesions in the brain due to a motion artifact of the head during the procedure

Discussion

Conclusion

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