CHRONIC Q-FEVER

  • 1 January 1976
    • journal article
    • research article
    • Vol. 45  (178) , 193-217
Abstract
Sixteen cases of chronic Q fever are described. In 8 there was a history of exposure to infection from farms or farm products. All had valvular heart disease and embolisms were common. Complement fixing antibodies to phase 1 antigen were found in titers .gtoreq. 1:200 in all but 2 patients. One post-mortem examination revealed rickettsial bodies in mitral valve vegetations; in another Coxiella burnetii was isolated from heart valve tissue. The majority presented with infective endocarditis. All patients had evidence of liver involvement, abnormal liver function and histology, and in 1 this led to death from cirrhosis. Hyperglobulinemia elevated alkaline phosphatase and abnormal bromsulphthalein retention were found in all patients. Hepatic histological abnormality was prevalent. Six patients had a purpuric rash, and in 12 there was thrombocytopenia. The presence of hepatomegaly and liver involvement and thrombocytopenia may help to differentiate Q fever endocarditis from bacterial endocarditis. Raised serum IgM [immunoglobulin M] and IgA levels occurred frequently, but with only a moderate dominance of IgM. Sheep cell agglutination and latex fixation tests for rheumatoid factor were occassionally positive. 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 hemodynamic reasons. Of the 11 survivors, 3 survived for > 5 yr, and another 6 for > 3.5 yr after diagnosis. Antibiotic therapy with tetracycline and lincomycin may control the disease; valve surgery may not be necessary to achieve this. Because this organism can persist in a quiescent form for long periods even without treatment, careful monitoring of these patients after treatment is withdrawn is recommended.