title: Chronic Q fever in the United States.
abstract: 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.
authors.affiliation: Department of Medicine, Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, MD 21231-1002, USA. petros@jhmi.edu
authors.forename: Petros C
authors.initials: PC
authors.lastname: Karakousis
authors.forename: Michele
authors.initials: M
authors.lastname: Trucksis
authors.forename: J Stephen
authors.initials: JS
authors.lastname: Dumler
mesh_terms: D000328:Adult; D000907:Antibodies, Bacterial / Q000097:blood; D002908:Chronic Disease; D016997:Coxiella burnetii / Q000276:immunology / Q000302:isolation & purification*; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology*; D006801:Humans; D008297:Male; D011778:Q Fever / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology*; D014481:United States / Q000453:epidemiology
chemical_list: D000907:Antibodies, Bacterial