Chronic Q Fever: Ninety-two Cases From France, Including 27 Cases Without Endocarditis

doi:10.1001/archinte.1993.00410050074010

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Vol. 153 No. 5, 8 MAR 1993

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Chronic Q Fever

Ninety-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

Objective
Chronic Q fever is seldom recognized; before 1989, only 234cases had been reported in the literature. The 92 cases of chronicQ fever collected at the French National Reference Center forRickettsioses from 1982 through 1990 represent the largest seriesever reported.

Patients
The patients included in the study were diagnosed between July31, 1982, and August 1, 1990, at the French National ReferenceCenter for Rickettsioses as having chronic Q fever by the followingcriteria: presence of antibody against Coxiella burnetii phaseI antigen at a titer greater than or equal to 800 for IgG and50 for IgA by the indirect immunofluorescence test. Epidemiologic,clinical, laboratory, and treatment data were collected from39 different collaborative hospitals throughout France.

Main Outcome Measure
For each serologically selected patient, a computerized questionnairewas 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 thanin rural inhabitants, and exposure to domestic ruminants andraw milk is an important feature. Immunocompromising conditions(20.2%) and underlying heart disease (88.4%) or vascular diseaseare the most important risk factors to consider in potentialcases of chronic Q fever. The mortality in these patients withendocarditis was high (23.5%). The clinical spectrum of 84 patientsincluded 57 cases of endocarditis, three cases of vascular prosthesisinfection, three cases of aneurysmal infection, three casesof osteoarthritis, four cases with lung localizations, nineasymptomatic cases, three cases of hepatitis, and two caseswith cutaneous forms of the disease.

Conclusions
In patients with unexplained fever, negative blood cultures,and a history of underlying vascular or cardiac disease, Q fevershould 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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