title: A fatal case of disseminated chronic Q fever: a case report and brief review of the literature.
abstract: BACKGROUND
  Chronic Q fever is a rare infection, which mainly manifests as endocarditis, infection of vascular prostheses or aortic aneurysms. We present the case of a 74-year-old immunocompromised man with a haematologically disseminated Coxiella burnetii infection, which has never been reported before.
  
  
  METHODS
  He was diagnosed with a chronic Q fever infection of an aneurysm with an endovascular prosthesis in 2015, but he died despite optimal treatment. Autopsy revealed a disseminated C. burnetii infection, confirmed by a positive PCR on samples from several organs. Retrospectively, he already had complaints and signs of inflammation since 2012, for which he had already been admitted in February 2014. At that time, Q fever diagnostics using PCR, complement fixation assay, and enzyme-linked immunosorbent assay on serum were all negative. In retrospect however, retesting available samples from February 2014 using immunofluorescence assay (IFA) already revealed serology compatible with chronic Q fever.
  
  
  CONCLUSIONS
  Clinicians should be aware of this silent killer, especially in case of risk factors, and perform an appropriate diagnostic work-up for Q fever including IFA serology and PCR.
authors.affiliation: Division of Infectious Diseases 463, Department of Internal Medicine, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. Stephan.Keijmel@radboudumc.nl.|Radboud Expert Centre for Q fever, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. Stephan.Keijmel@radboudumc.nl.
authors.forename: Stephan P
authors.initials: SP
authors.lastname: Keijmel
authors.affiliation: Division of Infectious Diseases 463, Department of Internal Medicine, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.|Radboud Expert Centre for Q fever, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Ruud P H
authors.initials: RP
authors.lastname: Raijmakers
authors.affiliation: Division of Infectious Diseases 463, Department of Internal Medicine, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.|Radboud Expert Centre for Q fever, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Teske
authors.initials: T
authors.lastname: Schoffelen
authors.affiliation: Department of Pathology, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Maria C W
authors.initials: MC
authors.lastname: Salet
authors.affiliation: Division of Infectious Diseases 463, Department of Internal Medicine, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.|Radboud Expert Centre for Q fever, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Chantal P
authors.initials: CP
authors.lastname: Bleeker-Rovers
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery; D001807:Blood Vessel Prosthesis / Q000382:microbiology*; D002908:Chronic Disease; D003168:Complement Fixation Tests; D016997:Coxiella burnetii / Q000302:isolation & purification*; D004797:Enzyme-Linked Immunosorbent Assay; D017809:Fatal Outcome; D005455:Fluorescent Antibody Technique; D006801:Humans; D008297:Male; D016133:Polymerase Chain Reaction; D011778:Q Fever / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D012307:Risk Factors; D019616:Thoracic Surgical Procedures / Q000009:adverse effects
keywords: Chronic Q fever; Coxiella burnetii; Disseminated infection; Fatal; Q fever