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Localizing chronic Q fever: a challenging query.

Dennis G Barten1, Corine E Delsing, Stephan P Keijmel

  • 1Radboud Expertise Centre for Q fever, Department of Internal Medicine, Division of Infectious Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands. C.Bleeker-Rovers@AIG.umcn.nl.

BMC Infectious Diseases
|September 6, 2013
PubMed
Summary
This summary is machine-generated.

18F-FDG PET/CT effectively localizes vascular infections in chronic Q fever patients. This imaging is crucial, especially since many patients don't recall acute Q fever, highlighting the need for high clinical suspicion.

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Area of Science:

  • Infectious Diseases
  • Radiology
  • Cardiology

Background:

  • Chronic Q fever commonly manifests as endocarditis or endovascular infections.
  • Accurate localization of infection is critical for effective treatment.
  • The diagnostic utility of imaging modalities and modified Duke criteria requires further investigation.

Purpose of the Study:

  • To evaluate the effectiveness of 18F-FDG PET/CT and echocardiography in detecting the site of chronic Q fever infection.
  • To assess the applicability of the modified Duke criteria in diagnosing chronic Q fever.
  • To identify risk factors and clinical outcomes associated with chronic Q fever.

Main Methods:

  • Retrospective analysis of 52 patients with confirmed or suspected chronic Q fever based on serology or PCR.
  • Inclusion criteria: high IgG titers against C. burnetii or positive PCR.
  • Data collected included serology, imaging results (18F-FDG PET/CT, TTE, TEE), risk factors, and clinical outcomes.

Main Results:

  • Of 52 patients, 18 had proven, 14 probable, and 20 possible chronic Q fever.
  • In proven cases, mycotic aneurysms (39%) were most common, followed by endocarditis (22%) and infected vascular prosthesis (17%).
  • 18F-FDG PET/CT localized infection in 10/13 proven cases, while TTE and TEE were less effective (6% and 50%, respectively).

Conclusions:

  • 18F-FDG PET/CT is a valuable tool for localizing vascular infections in chronic Q fever.
  • Mycotic aneurysms are more frequently diagnosed in chronic Q fever than previously reported.
  • High clinical suspicion for chronic Q fever is essential, particularly in endemic areas, as acute infection history is often absent.