Clinical characteristics of chronic Q fever: an analysis of 12 cases / 中华全科医师杂志

ABSTRACT

Objective:To analyze the clinical characteristics of chronic Q fever.Methods:The epidemiological characteristics, clinical manifestations, laboratory results, diagnosis, treatment and prognosis of 12 patients with chronic Q fever admitted in Peking Union Medical College Hospital from January 2008 to December 2022 were analyzed retrospectively.Results:Of the12 cases, there were 11 males and 1 female with a median age at diagnosis of 58 years (47-68). The median time interval between the onset of symptoms and diagnosis was 9.5 months (4.0-28.5). Ten patients had fever, and the common symptoms included weakness ( n=6), weight loss ( n=5) and shortness of breath ( n=3). Seven patients presented with hepatomegaly and splenomegaly. Among the 12 patients, 1 patient suffered from cardiac valve and artery involvement at the same time, 8 patients suffered from infective endocarditis, and 1 patient suffered from aneurysm. No definite infection site was found in 2 patients. Seven of the 12 patients (58.3%) had elevated serum creatinine. Rheumatoid factors were detected in 8 patients, all of which were elevated. Nine patients were treated with doxycycline/minocycline plus hydroxylchloroquine and 3 patients were treated with doxycycline/minocycline. Patients were followed up for 3 months to 14 years, 7 patients stopped antibiotics after 12 to 30 months and were in stable condition. One patient died of heart failure 6 months after diagnosis and 1 patient lost follow-up. Three patients diagnosed in 2022 were still under treatment and in stable condition. Conclusions:The clinical manifestations of chronic Q fever lack of specificity and may involve multiple systems. Endocarditis and mycotic aneurysm are common complications. For long-term fever with new heart valve function damage or mycotic aneurysm patients, chronic Q fever should therefore be considered.