Q Fever in the Southern California Desert: Epidemiology, Clinical Presentation and Treatment

Cone, Lawrence A.; Curry, Noel; Shaver, Phillip R.; Brooks, David; DeForge, James R.; Potts, Barbara E.

doi:10.4269/ajtmh.2006.75.1.0750029

Cited by 12 publications

(8 citation statements)

References 27 publications

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“…16,17 These studies reported that the largest number of serologically positive animals were from southern California, as compared with northern California, and suggested sheep and goats were primarily responsible for harboring the disease in the north, whereas cattle were predominantly responsible in the south. 18,19 Not many studies on Q fever in southern California have been conducted recently, and to our knowledge, the most recent study was published in 2006 by Cone et al, 20 who described six cases of Q fever which presented over 32 years in the southern California desert.…”

Section: Introductionmentioning

confidence: 99%

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

Akamine

Perez

Lee

et al. 2019

The American Journal of Tropical Medicine and Hygiene

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. 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.

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Section: Introductionmentioning

confidence: 99%

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

Akamine

Perez

Lee

et al. 2019

The American Journal of Tropical Medicine and Hygiene

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“…A liver biopsy can be helpful for diagnosis, particularly in patients with acute Q fever presenting as hepatitis. Although fibrin ring granulomas are characteristic in acute Q fever hepatitis,12 details of the pathological features have not been described. Herein, we report the clinical and pathological features of liver biopsies from seven cases of acute Q fever.…”

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confidence: 99%

Clinicopathologic Features of Q Fever Patients with Acute Hepatitis

et al. 2012

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Background Q fever caused by Coxiella burnetii presents with diverse clinical and pathological features including subclinical or cholestatic hepatitis. However, the pathological features of liver biopsies from patients with Q fever have not been well described. Methods Clinical features and pathological findings of liver biopsies were reviewed in seven cases of Q fever that were confirmed by serological, microbiological, or molecular tests. Results All cases presented with fever. Liver enzymes were mildly elevated except one case with marked hyperbilirubinemia. Characteristic fibrin ring granulomas were present in three cases, epithelioid granulomas with eosinophilic infiltration in two cases, extensive extravasated fibrins without ring configuration mimicking necrotizing granuloma in one case, and acute cholangitis without granuloma in one case. All cases were treated with antibiotics for 20 days. Six cases were completely cured, but one suffered from multiorgan failure. Conclusions C. burnetii infection is uncommon, but should always be considered in patients with acute hepatitis and fever. Because variable-sized circumferential or radiating fibrin deposition was a consistent feature of the present cases, Q fever can be strongly suggested by pathological features and confirmed by serological and/or molecular tests.

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“…The granulomas of Q fever are histologically characterized by a clear central space with a fibrinoid type of ring, which is consistent with the biopsy specimen of this patient. Although this type of granuloma is thought to be characteristic of Q fever hepatitis [7], it is not pathognomic. It has also been described in patients with leishmaniasis, infectious mononucleosis, giant-cell arthritis, and allopurinol hypersensitivity [8][9][10][11].…”

Section: Discussionmentioning

confidence: 96%

A Case of Acute Q Fever Hepatitis Diagnosed by F-18 FDG PET/CT

Baek

Lee

et al. 2012

Nucl Med Mol Imaging

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A 53-year-old man with fever of unknown origin underwent F-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) as a workup for a fever of unknown origin. On presentation, he complained of fever, chills, and myalgia. The F-18 FDG PET/CT scan showed diffusely increased uptake of the liver with mild hepatomegaly. A liver biopsy then revealed fibrin-ring granulomas typically seen in Q fever. The patient was later serologically diagnosed as having acute Q fever as the titers for C. burnetii IgM and IgG were 64:1 and 16:1, respectively. He recovered completely following administration of doxycycline. This indicates that F-18 FDG PET/CT may be helpful for identifying hepatic involvement in Q fever as a cause of fever of unknown origin.

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Q Fever in the Southern California Desert: Epidemiology, Clinical Presentation and Treatment

Cited by 12 publications

References 27 publications

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

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

Clinicopathologic Features of Q Fever Patients with Acute Hepatitis

A Case of Acute Q Fever Hepatitis Diagnosed by F-18 FDG PET/CT

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