Karakousis Petros C, Trucksis Michele, Dumler J Stephen
Department of Medicine, Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, MD 21231-1002, USA.
J Clin Microbiol. 2006 Jun;44(6):2283-7. doi: 10.1128/JCM.02365-05.
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.
Q热的病原体伯纳特柯克斯体引起的感染在美国并不常见。慢性Q热病例极为罕见，最常见的表现是患有潜在瓣膜性心脏病的患者出现血培养阴性的心内膜炎。我们描述了一名来自西弗吉尼亚州的31岁农民，他有先天性心脏病史，反复发热14个月，基于针对伯纳特柯克斯体I相抗原的极高抗体滴度被诊断为Q热心内膜炎。尽管接受了强力霉素治疗，但在初次诊断后的10年里，他的伯纳特柯克斯体I相抗体滴度仍持续显著升高。据我们所知，该病例是美国慢性Q热患者随访时间最长的病例。我们回顾了美国报告的所有慢性Q热病例，并讨论了与该疾病的流行病学、诊断和管理相关的重要问题。
