Editorial: Chronic Q fever or Q fever endocarditis?
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Chronic Disease↗
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Chronic Q fever.
Sixteen cases of chronic Q fever are described. In eight there was a history of exposure to infection from farms or farm products. All had valvular heart disease, involving the mitral valve in nine and the aortic valve in seven. Infection occurred on a prosthetic valve in two patients. Arterial embolism was common. Venous thrombosis occured in three patients, and pulmonary embolism occurred in three other patients. Complement fixing antibodies to phase 1 antigen were found in a titre of 1:200 or greater in all except two patients. In one of these post-mortem examination revealed rickettsial bodies in mitral valve vegetations, and in the other Coxiella burneti was isolated from heart valve tissue. The majority presented with infective endocarditis but two presented primarily with liver disease. All patients had evidence of liver involvement and in one this led to death from cirrhosis. Abnormal tests of liver function, particularly hyperglobulinaemia, raised alkaline phsophatase and abnormal bromsulphthalein retention were found in all patients. Hepatic histology was abnormal in all eight patients in whom it was studied. The commonest features were mononuclear cell infiltration of the portal tracts and prominence of the sinusoidal Kupffer cells. Patchy focal necrosis of parenchymal cells, granulomata, fatty change, and eosinophilia of the sinusoidal walls were also noted in several patients and cirrhosis developed in one. Six patients had a purpuric rash, and in 12 there was thrombocytopenia. It is suggested that the presence of hepatomegaly and liver involvement and thrombocytopenia may help to differentiate Q fever endocarditis from bacterial endocarditis. Raised serum IgM and IgA levels occured frequently, but with only a moderate dominance of IgM. Sheep cell agglutination and latex fixation tests for rheumatoid factor were occasionally positive. Several features of the disease suggest the possibility that immune-complex mechanisms may play a role in chronic Q fever. Treatment was with prolonged courses of tetracycline usually combined with lincomycin. Seven patients underwent valve replacement surgery for haemodynamic reasons. Five patients died; two from heart failure, one from cirrhosis, one seven days after valve replacement and one from intraperitoneal haemorrhage following percutaneous liver biopsy. Three patients have survived for more than five years, and another six for more than three and a half years after diagnosis. Of these nine patients, three received medical therapy alone and six required valve replacement as well. Antibiotics have been discontinued in four patients who have had valve surgery and three others. Six patients had received antibiotics for continuous periods varying from 29-62 months. In the period after stopping therapy varying from 15-21 months, no relapse has occured. A seventh patient, who had received antibiotics for four months prior to valve replacement, has survived 43 months after the withdrawal of antibiotics...
Adult↗
[Radiograph and observation of the development of Q-fever pneumonia (author's transl)].
The radiograph in Q-fever pneumonia and the course of Q-fever was reported with the help of 12 clinically examined cases. Q-fever pneumonia is not to be diffrentiated from viral pneumonia or mycoplasmal pneumonia. A chronic course with residual infiltrates which lasts as long as two or three months is, however, more frequent in Q-fever pneumonia. According to our observations, a correlation seems to exist between the severity of the clinical symptoms, the extent of the pulmonary infiltrate and the level of the titer of the complement fixation.
Antibodies↗
Incidence of Q fever in two inadequately investigated occupational groups.
In 1973 the authors investigated the incidence of Q fever serologically by means of the reaction of complement fixation (RCF) and the method of immunofluorescent titration (MIFT) in two inadequately investigated occupational groups--communal workers from the town of Russe and medical workers in obstetric departments of several towns in North Bulgaria. In addition, they carried out comparative studies in order to characterize the incidence and the degree of affection from the same disease in other persons exposed and not exposed at work in the same area--transport workers and blood donors. Out of 198 communal workers, 91 (45.95 +/- 3.54%) had positive titres for Q fever (1:8--1:512). A high incidence of Q fever was established in dustmen (61.40%), sweepers (46.55%) and drivers of dust cars (38.00%), i.e. persons collecting and rendering harmless the garbage of big town. Out of 174 medical workers in obstetric departments 65 (37.36% +/- 3.78%) were positive in titres 1:8--1:512. A high incidence of Q fever was established in obstetricians (57.14%), midwives (38.11%) and hospital attendants (34.38%), i.e. persons providing medical care for pregnant women or women in childbirth. In both groups the occupational hazard increases with the length of service. Out of 244 transport workers 82 (33.60% +/- 3.02%) were positive for Q fever, and out of 237 blood donors 19 (8.01 +/- 2.54%) were serologically positive for Q fever. The authors suggest continued investigation of these two occupational groups.
Bulgaria↗
Q fever endocarditis in the United States.
A patient with Q fever endocarditis, which is almost unknown in the United States, was followed for a total of 32 months; the study was begun 3 1/2 months before aortic valve replacement. Diagnosis was confirmed by serology, visualization of Coxiella burnetii in excised aortic valve tissue by direct and immunofluorescence staining, and isolation of C. burnetii from aortic valve tissue. Serum antibodies against phase I and phase II antigens of C. burnetii were identified. Almost all phase I and phase II antibodies were IgG. These findings are compared with those in an uncomplicated case of acute Q fever. New findings on the immune response to chronic Q fever are presented.
Animals↗
Sero-epidemiology of Q-fever in poultry.
The sero-epidemiology of Q-fever was studied by capillary agglutination test at 25 poultry farms in the Nainital and Ajmer districts of Uttar Pradesh and Rajasthan. Of 589 birds tested, 78 (13.24%) had Q-fever agglutinins (CAT titers 1:8 to 1:64), involving 16 of the farms. There were more sero-reactors in Ajmer (17.56%) than in Nainital (3.35%). The sero-positive reactors were respectively 19.74% and 5.55% among the age groups above and below 6 months. The breed difference and comparatively high infection rates in poultry attendants of a Q-fever-positive farm are discussed.
Animals↗
Q fever endocarditis: a report of 2 cases.
Two patients with Q fever endocarditis are described. Both patients demonstrated some of the characteristic features of Q fever endocarditis, i.e. the long course of the disease before diagnosis, persistently negative blood cultures, resistance to conventional antibiotic therapy and a dramatic response to tetracycline therapy. Complications included arteriovenous thrombo-embolism and hepatic enlargement, and 1 patient developed an immune complex form of glomerulonephritis. The possibility of Q fever endocarditis should be considered in all patients with infective endocarditis in whom blood cultures are negative and who fail to respond to conventional antibiotic therapy.
Adult↗
Global Seroprevalence of Q Fever Antibodies to Coxiella burnetii in Children and Adolescents : A Systematic Review and Meta-analysis.
OBJECTIVE: To comprehensively determine global estimates of Q fever seroprevalence in children and adolescents by conducting a systematic review and meta-analysis. DATA SOURCES: Searches of published articles in MEDLINE, Embase and Scopus databases were conducted from inception until February 2025. STUDY SELECTION: Cross-sectional studies reporting seroprevalence of Q fever/ Coxiella burnetii antibodies, using any established laboratory test, in any population of healthy children and adolescents <20 years old were included. The quality of eligible articles was assessed using a modified Newcastle-Ottawa Scale. DATA EXTRACTION: Data from eligible articles were extracted using a standardized form, which included year of publication, year(s) the study was conducted, numbers of antibody-positive cases/specific population, age, country, geographic region, serology test used and antibody titer cutoff value. DATA SYNTHESIS: DerSimonian and Laird random effects models were used to calculate pooled seroprevalence estimates and 95% confidence intervals in data from 41 eligible articles reporting 42 studies comprising 9841 children and adolescents. Q fever seroprevalence was observed in multiple countries across 7 geographic regions, and varied markedly between countries and regions, with the highest estimate observed by an individual country in Ethiopia (45%) and by region in the Middle East (14%). Seroprevalence estimates were higher in older children and adolescents ≥10 years (15%) compared with younger children <10 years of age (8%). CONCLUSION: Despite varying geographical prevalence, our findings demonstrate that widespread exposure to Q fever antigens occurs across multiple global regions in children and adolescents to potentially serious C. burnetii infection, indicating that diagnostic surveillance and preventive measures should be considered in both endemic and previously unreported areas.
Humans↗
Mesangio-capillary glomerulonephritis associated with Q-fever endocarditis.
A patient with nephrotic syndrome and Q-fever endocarditis (confirmed serologically and ultrastructurally) was found to have mesangio-capillary glomerulonephritis with parietal deposits of C3 and IgM and some IgM in the mesangium. Elution studies showed that IgM antibodies reactive against insoluble Coxiella antigens were present in the kidney. Review of the literature suggests that this type of immune complex nephritis may be associated with Q-fever. Possible reasons for the variability of the nephritis associated with infective endocarditis are discussed.
Adult↗
Vaccination of cattle against Q-fever.
Formalin-killed phase I C. burneti organisms containing the protective antigenic component were used for vaccination of heifers against Q fever. None of the vaccinated heifers contracted Q fever, whereas 8 out of 12 (66.6%) control, non-vaccinated heifers became infected when exposed to infection for 3 months in the breed of naturally infected dairy cows. In the vaccinated cattle C. burneti was detected immediately post partum neither in the placenta nor in the colostrum. No shedding of C. burneti in milk has been found so far during 3 years of post-vaccinal observation period. For detecting Q fever antibodies in the blood of vaccinated as well as naturally infected animals MAR was found more sensitive than CFR.
Agglutination Tests↗
Q-fever soluble vaccine effects in Coxiella burneti sensitized humans.
A Q-fever soluble vaccine (phase I C. burnetitrichloro-acetic acid extract) was administered in a single dose to 28 persons formerly immunized with the same soluble vaccine one year before and to other 28 persons which had naturally been infected with C. burneti one or two years ago. All these persons were skin-tested with the same but diluted vaccine 48 hrs before vaccination. Mild local and general reactions were found only in the C. burneti previously infected vaccinees (local reactions in 9 cases and general reactions in 6 cases). Serological conversion was obtained in 92.8% (complement fixation test) and in 89.3% (mouse protection test) of the previously immunized individuals and in 96.4% (CF test) of the formerly Q-fever infected persons.
Antibodies, Bacterial↗
The chest film findings in 'Q' fever--a series of 35 cases.
Thirty-five cases of 'Q' fever have been admitted and confirmed serologically over the past 20 years. Thirty-two of these cases had chest films on admission, and lung changes were present in 87%. The lung changes were: 1. Multiple round segmental consolidations, 5--10 cm in diameter, of ground glass density and usually situated in the lower lobes. 2. Linear atelectasis. 3. Lobar or partial lobar consolidation, with some loss of volume in the affected lobe. 4. A slight pleural reaction in a few cases. 5. Some cases had background emphysema of the lungs. All the lesions tended to be slow to clear. The resolution time was from 10 to 70 days, with an average time fo 30 days. Some of the segmental lesions became small, round and dense during resolution. The 35 cases were almost exclusively in males. The finding of a single or multiple round segmental opacities of ground glass density, as described, especially with linear atelectasis, was found to be good evidence that the patient had 'Q' fever. The point is made that the admission chest film is in some cases a very useful early pointer to the diagnosis. This allows specific chemotherapy to be started before the serological results have come back. Plate atelectasis was helpful as a distinguishing feature from primary atypical pneumonia.
Adolescent↗
Bone marrow granulomas in Q fever.
This report describes the case of a patient who had a fever of unknown origin and granulomatous hepatitis. Numerous granulomas were present in sections from a bone-marrow biopsy and bone-marrow clot obtained as a part of the diagnostic evaluation. Subsequent serologic studies proved the patient had Q fever. The authors re-emphasize that a distinctive form of granuloma occurs in the bone marrow with Q fever and that Q fever should always be a consideration in the differential diagnosis of bone-marrow granulomas.
Adult↗
Vaccination of dairy cattle against Q fever (Coxiella burneti): results of field trials.
A phase I formalin-inactivated Q fever vaccine, using the Nine Mile strain of the organism, was tested for its ability to prevent dairy cows from shedding Coxiella burnetti in their milk. More than 1,400 Holstein-Friesian dairy calves and heifers from 5 dairies were used in field trials lasting over a 3-year period. Vaccination of 476 calves resulted in a geometric mean antibody titer of 1:123.3 compared with 1:2.4 for 486 nonvaccinated calves. The milk samples from 163 vaccinated calves were tested by mouse inoculation after the cows commenced lactation and were placed in their respective milking herds. Of these vaccinated animals, only 2 cows (1%) from 1 herd were suspected shedders, but on subsequent testing gave negative results. Among 164 nonvaccinated (control) cows, 39 (24%) were shedding C burnetii in their milk; this figure corresponded to the prevalence (23%) of shedders in the general population of dairy cows in California. The results of the current field trials indicated that vaccination greatly reduced the shedding of the Q fever organism in the milk of dairy cows.
Animals↗
[Q-Fever and its complications (author's transl)].
Q-Fever recurs as localized epidemics in the German Federal Republic. The disease has not previously been observed in North Hesse. During a familial infection with Coxiella burneti a 15-year-old boy together with his parents and an aunt became ill with atypical pneumonia. After the pulmonary symptoms had subsided a deep left leg and pelvic venous thrombosis occurred in the boy in the fifth week after the onset of the disease. The thrombosis which is very rare in childhood could be successfully removed at operation.
Adolescent↗
Q fever endocarditis in Queensland.
Thirteen patients with proven Q fever endocarditis and three additional patients with probable endocarditis are reviewed. The most helpful diagnostic test is the demonstration of a high complement fixing antibody titre to Phase 1 antigen of Coxiella burneti. The macroscopic pathology of the aortic valve is described and includes aneurysmal pockets in the aortic wall and valve annulus which are demonstrable angiographically. Evidence is presented that the infection may be controlled by prolonged tetracycline therapy and that this is accompanied by a falling antibody titre to Phase 1 antigen. Valve replacement is undertaken only for symptomatic and hemodynamic indications. The combined tetracycline therapy and valve replacement have produced a fall in titres with eradication of infection and palliation of the cardiac disability in all patients followed for long periods.
Adult↗
Q fever and animal abortion in Cyprus.
Seventy-eight British soldiers stationed in the Eastern Sovereign Base Area (ESBA) in Cyprus contracted Q fever in the period December 1974 to June 1975. Pneumonia developed in 59% of cases. Of 31 patients tested, 81% had biochemical evidence of hepatitis although only one became clinically jaundiced. Three patients (4%) suffered pericarditis. Treatment with tetracycline had no apparent effect on the course of the disease. Investigation revealed an abortion epidemic involving 21 mixed flocks of sheep and goats in the south-eastern coastal region. 11 of the flocks grazed in and around the ESBA. A serological survey of 10 affected flocks, and evidence collected from previous years, indicated that the abortion epidemic was the result of infection with Coxiella burneti. Infection in the humans was almost certainly acquired by inhalation of dust from brush contaminated with rickettsial parturition products of the aborting flocks. A human serological survey revealed a number of cases of subclinical Q fever in a susceptivle military population, and an asymptomatic epidemic in a largely immune local position.
Abortion, Veterinary↗
[Epidemic focus of Q fever in a rural location in the Suceava district].
A Q fever epidemic focus with 46 cases was detected in a rural locality among the workmen of livestock farms. In 33 cases, the subclinical and inapparent form of the disease was detected by serologic tests, performed in the focus. Complement fixation antibody titers persisting in very high titers, a retrospective diagnosis of infection may be established even 3-4 months after the onset of the disease.
Adult↗