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Chronic sternal wound infection and endocarditis with Coxiella burnetii
M Ghassemi1, W A Agger, R E Vanscoy
1Department of Medical Education, Gundersen-Lutheran Medical Foundation, La Crosse, Wisconsin, USA.
Abstract:
Chronic Q fever is most commonly associated with culture-negative endocarditis and less frequently with infection of vascular grafts, infection of aneurysms, hepatitis, pulmonary disease, osteomyelitis, and neurological abnormalities. We report a case of chronic sternal wound infection, polyclonal gammopathy, and mixed cryoglobulinemia in which Q fever endocarditis was subsequently diagnosed. Polymerase chain reaction analysis of the wound tissue was positive for Coxiella burnetii DNA, and treatment of the endocarditis resulted in prompt healing of the wound. Chronic Q fever can occur without epidemiological risk factors for C. burnetii exposure and can produce multisystem inflammatory dysfunction, aberrations of the immune system, and persistent wound infections.
Insights
Chronic Q fever, often linked to heart infections, can also cause persistent wound issues. This case highlights Coxiella burnetii
Area of Science:
- Infectious Diseases
- Rheumatology
- Immunology
Background:
- Chronic Q fever commonly presents as culture-negative endocarditis.
- Other manifestations include vascular graft infections, hepatitis, and neurological issues.
Observation:
- A patient presented with chronic sternal wound infection, polyclonal gammopathy, and mixed cryoglobulinemia.
- Q fever endocarditis was diagnosed and confirmed by Coxiella burnetii DNA in wound tissue.
Findings:
- Polymerase chain reaction confirmed Coxiella burnetii DNA in the sternal wound.
- Successful treatment of Q fever endocarditis led to rapid wound healing.
Implications:
- Chronic Q fever can manifest without typical exposure risks.
- It can lead to multisystem inflammation and immune system dysfunction.
- Persistent wound infections may be an unrecognized presentation of chronic Q fever.
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