Q Fever in Southern California: a Case Series of 20 Patients from a VA Medical Center

Abstract

. Query fever (Q fever), caused by Coxiella burnetii , was first described in southern California in 1947. It was found to be endemic and enzoonotic to the region and associated with exposure to livestock. We describe a series of 20 patients diagnosed with Q fever at a Veterans Affairs hospital in southern California, with the aim of contributing toward the understanding of Q fever in this region. Demographics, laboratory data, diagnostic imaging, risk factors, and treatment regimens were collected via a retrospective chart review of patients diagnosed with Q fever at our institution between 2000 and 2016. Cases were categorized as acute or chronic and confirmed or probable. The majority presented with an acute febrile illness (90%). There was a delay in ordering diagnostic serology from the time of symptom onset (acute cases, average 31.9 days; chronic cases, average 63 days), and 15% progressed from acute to chronic infection. Of the chronic cases, 22.2% had endocarditis, 22.2% had endovascular infection, and 11.1% had both endocarditis and endovascular infection. The geographic distribution revealed that 20% resided in rural areas. Of the cases of Q fever that died, death attributed to Q fever was associated with an average diagnostic delay of 65.5 days. Acute Q fever is underreported in this region largely because of its often nonspecific clinical presentation.

Epidemiological scenario of Q fever hospitalized patients in the Spanish Health System: What’s new

“…Our lethality rate was 2.8%, which is similar to the rate described in the USA from 2000 to 2012 (2%) (Dahlgren et al, 2015b). Nevertheless, a recent study in California described a lethality rate of 10% (Akamine et al, 2019), and the death attributed to QF was associated with an average diagnostic delay of 65.5 days (Akamine et al, 2019). Our data show that older patients have a more severe clinical picture and higher mortality.…”

“…The mortality rate of QF is less than 3% (Anderson et al, 2013;Eldin et al, 2017;Woldehiwet, 2004), though a recent study in California described a lethality rate of 10% (Akamine et al, 2019). We have not found studies about the economic impact of QF in Spain.…”

“…A very slight decrease in the mortality rate was observed during the period of our study (1.96 in 1998 and 1.32 in 2015). Although we cannot extrapolate our results to the general population (since we only include hospitalized patients), it is possible to appreciate that they are in the same line as available literature (Akamine et al, 2019).…”

Q Fever in Southern California: 11 Patient Cases from a Community-Based Organization

“…In addition, exposure to goats and cattle was the predominant risk factor for infection in our patients than exposure to rodents, dogs, cats, and sheep as reported in other studies in southern California. 1,2 We identified two female patients with Q fever as compared with none by Akamine et al 1 Another distinctive finding from other studies is almost half of our patients were diabetic (five) and of Hispanic/Latino (five) descent. 1,2…”

“…We read with great interest the case series of 20 patients with Q fever from a VA Medical Center in southern California by Akamine et al 1 We applaud the authors’ efforts to create greater awareness for an infection that is considered underreported in this region.…”