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Journal of Clinical Microbiology, June 2006, p. 2283-2287, Vol. 44, No. 6
0095-1137/06/$08.00+0     doi:10.1128/JCM.02365-05
Copyright © 2006, American Society for Microbiology. All Rights Reserved.

CASE REPORT

Chronic Q Fever in the United States

Petros C. Karakousis,1* Michele Trucksis,2 and J. Stephen Dumler3

Departments of Medicine,1 Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland,3 Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts2

Received 11 November 2005/ Returned for modification 11 March 2006/ Accepted 26 March 2006

Infections due to Coxiella burnetii, the causative agent of Q fever, are uncommon in the United States. Cases of chronic Q fever are extremely rare and most often manifest as culture-negative endocarditis in patients with underlying valvular heart disease. We describe a 31-year-old farmer from West Virginia with a history of congenital heart disease and recurrent fevers for 14 months who was diagnosed with Q fever endocarditis based on an extremely high antibody titer against Coxiella burnetii phase I antigen. Despite treatment with doxycycline, he continued to have markedly elevated Coxiella burnetii phase I antibody titers for 10 years after the initial diagnosis. To our knowledge, this case represents the longest follow-up period for a patient with chronic Q fever in the United States. We review all cases of chronic Q fever reported in the United States and discuss important issues pertaining to epidemiology, diagnosis, and management of this disease.

* Corresponding author. Mailing address: Center for Tuberculosis Research, Johns Hopkins University School of Medicine, 1550 Orleans St., Room 106, Baltimore, MD 21231-1002. Phone: (410) 502-8233. Fax: (410) 614-8173. E-mail: petros{at}jhmi.edu.

Journal of Clinical Microbiology, June 2006, p. 2283-2287, Vol. 44, No. 6
0095-1137/06/$08.00+0     doi:10.1128/JCM.02365-05
Copyright © 2006, American Society for Microbiology. All Rights Reserved.



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