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Q fever is a worldwide zoonotic infection caused by Coxiella burnetii. In Belgium, the disease must be notified, and the incidence is low. Human contamination is mostly due to sheep and goats. Herein, we report a case of chronic Q fever presenting as a prolonged fever in a patient with a history of valve prosthesis. Blood culture-negative endocarditis was diagnosed through an assessment including echocardiography and systematic serological testing. Despite the absence of travel abroad or obvious contact with domestic or wildlife animals, C. burnetii phase I and phase II IgG antibody titers were > 1:8192, and polymerase chain reaction performed on blood was positive for C. burnetii. Genotypic single nucleotide polymorphism (SNP) analysis of the pathogen strain identified a SNP-type 1 genomic group, which is associated with small ruminants in Belgium. The epidemiological investigation did not confirm the presence of positive C. burnetii cattle or sheep herds in the vicinity of the patient’s workplace and home, nor in the pest animals surrounding the workplace. Patients with risk factors for chronic Q fever should be tested for C. burnetii infection in case of prolonged fever of unknown origin, osteomyelitis, abscess or blood culture-negative endocarditis, even in the absence of direct exposure to animals.

Suspicion threshold for opportunistic coinfections should be lowered in severe COVID‐19. Serum CMV polymerase chain reaction and colonoscopy should be discussed in presence of persistent digestive disturbances. [ABSTRACT FROM AUTHOR]

The serological prevalence of Epstein-Barr virus (EBV) among young adults exceeds 90% worldwide. Even though EBV primary infection is usually benign, severe complications can occur in adolescents and young adults and so the disease must be promptly diagnosed. The development of an oropharyngeal abscess leading to a descending necrotizing mediastinitis (DNM) is exceptional and potentially lethal, so early diagnosis with a CT scan, appropriate antibiotics and surgery are essential. The authors present a case where DNM was associated with reactive hemophagocytic syndrome as a result of infectious mononucleosis, as well as a review of similar cases in the English literature., Learning Points: The incidence of serious complications in Epstein-Barr virus (EBV) primary infection increases with age.Respiratory symptoms (e.g., pleuritic pain, dyspnoea) and unusually prolonged fever (>10 days) in patients with infectious mononucleosis could be 'red flags' for life-threatening complications such as empyema and descending necrotizing mediastinitis.The threshold for performing cervical and chest computed tomography in septic patients with infectious mononucleosis should be low., Competing Interests: Conflicts of Interests: The Authors declare that there are no competing interests., (© EFIM 2020.)