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Severe Localized Q Fever, a Diagnostic Challenge: Report of Two Cases and Review of the Literature

Authors :
Monica Muntean
Amanda Radulescu
Bogdan Caloian
Ioana Hiriscau
Mihaela Lupșe
Violeta Briciu
Source :
Microbiology Research, Vol 15, Iss 3, Pp 1728-1737 (2024)
Publication Year :
2024
Publisher :
MDPI AG, 2024.

Abstract

Coxiella burnetii (C. burnetii) can cause asymptomatic infections and acute, chronic, or localized manifestations affecting multiple organs. Doxycycline is the most effective treatment for Q fever. We report two cases of localized C. burnetii infections with no evident epidemiological link. Case reports: We present the case of a 51-year-old male patient admitted for low fever, dry cough, and malaise. The physical examination was unremarkable except for painful hepatomegaly. He was diagnosed with a liver abscess based on inflammatory markers, positive serology for C. burnetii, and abdominal computed tomography (CT) showing a large lesion (112/86/93 mm) within the right liver lobe. Blood cultures and the fluid obtained by percutaneous catheter drainage were negative. After 28 days of treatment with doxycycline, he was discharged well. At the three-month reevaluation, blood tests were normal, and a CT scan showed a minimal residual lesion. The second case was an 81-year-old female with many comorbidities, almost simultaneous acute ischemic stroke, and double-valve (native and prosthetic) infective endocarditis (IE). C. burnetii infection was confirmed by high titers of antibodies (phase I and II IgG), most probably the direct cause of both manifestations. These two cases presented with very rare manifestations of C. burnetii infections, highlighting its diagnostic difficulties. Conclusions: A clear distinction between acute and chronic Q fever is difficult in rare localized infections, as are organ abscesses. Coxiella burnetii may cause stroke and infective endocarditis, especially in the elderly. Even in the absence of epidemiological clues, in patients with localized infections, the C. burnetii etiology should be considered.

Details

Language :
English
ISSN :
20367481
Volume :
15
Issue :
3
Database :
Directory of Open Access Journals
Journal :
Microbiology Research
Publication Type :
Academic Journal
Accession number :
edsdoj.b0a69e4ab06f49d28fdf5c30fc56f2ff
Document Type :
article
Full Text :
https://doi.org/10.3390/microbiolres15030114