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Chronic Q FeverNinety-two Cases From France, Including 27 Cases Without Endocarditis
Philippe Brouqui, MD, PhD;
Hervé Tissot Dupont, MD, MPH;
Michel Drancourt, MD, PhD;
Yvon Berland, MD;
Jérome Etienne, MD;
Catherine Leport, MD;
Frederic Goldstein, MD;
Philippe Massip, MD;
Max Micoud, MD;
André Bertrand, MD;
Didier Raoult, MD, PhD
Arch Intern Med. 1993;153(5):642-648.
Abstract
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Objective
Chronic Q fever is seldom recognized; before 1989, only 234 cases had been reported in the literature. The 92 cases of chronic Q fever collected at the French National Reference Center for Rickettsioses from 1982 through 1990 represent the largest series ever reported.
Patients
The patients included in the study were diagnosed between July 31, 1982, and August 1, 1990, at the French National Reference Center for Rickettsioses as having chronic Q fever by the following criteria: presence of antibody against Coxiella burnetii phase I antigen at a titer greater than or equal to 800 for IgG and 50 for IgA by the indirect immunofluorescence test. Epidemiologic, clinical, laboratory, and treatment data were collected from 39 different collaborative hospitals throughout France.
Main Outcome Measure
For each serologically selected patient, a computerized questionnaire was utilized to record 188 different items of demographic, epidemiologic, clinical, laboratory, and therapeutic data, which were analyzed.
Results
Chronic Q fever occurs more frequently in city dwellers than in rural inhabitants, and exposure to domestic ruminants and raw milk is an important feature. Immunocompromising conditions (20.2%) and underlying heart disease (88.4%) or vascular disease are the most important risk factors to consider in potential cases of chronic Q fever. The mortality in these patients with endocarditis was high (23.5%). The clinical spectrum of 84 patients included 57 cases of endocarditis, three cases of vascular prosthesis infection, three cases of aneurysmal infection, three cases of osteoarthritis, four cases with lung localizations, nine asymptomatic cases, three cases of hepatitis, and two cases with cutaneous forms of the disease.
Conclusions
In patients with unexplained fever, negative blood cultures, and a history of underlying vascular or cardiac disease, Q fever should be considered.
(Arch Intern Med. 1993;153:642-648)
Author Affiliations
From the Rickettsia Unit, Faculté de Médecine (Drs Brouqui, Dupont, Drancourt, and Raoult), Nephrology and Renal Dialysis, CHU Sainte Marguerite (Dr Berland), Marseilles, France; Microbiology Laboratory, Hôpital Louis Pradel, Lyon, France (Dr Etienne); Infectious and Tropical Diseases Service, Groupe Hospitalier Bichat-Claude Bernard (Dr Leport), Medical Microbiology Laboratory, Hôpital St Joseph (Dr Goldstein), Paris, France; Infectious Diseases Service, CHU Hôpital Purpan, Toulouse, France (Dr Massip); Infectious Diseases Service, CHU Michalon, Grenoble, France (Dr Micoud); and Infectious Diseases Clinic A, Centre Guy de Chauliac, CHU St Eloi, Montpellier, France (Dr Bertrand).
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