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Coxiella burnetii vascular graft infection
Takaaki Kobayashi1, Fernando Casado Castillo1, Jason H Barker1
1Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Hospitals and Clinics, United States.
Abstract:
Q fever, a zoonotic infection caused by Coxiella burnetii, can present with a wide spectrum of clinical manifestations. The organism is typically transmitted from sheep, goats, or cattle to humans via contaminated aerosols. On average, 1-5% of patients with acute Q fever will develop chronic infection months to decades after their primary infections. We report a case of a chronic vascular graft infection due to Coxiella burnetii in a 61-year-old man without direct exposure to animals who presented with recurrent fever. Indium-111-labeled white blood cell scan with single-emission positron computed tomography demonstrated findings suggesting a graft infection. C. burnetii phase I and phase II IgG antibody titers were > 1:32,768 and polymerase chain reaction performed on the explanted graft was positive for C. burnetii. Q fever should be considered in the differential diagnosis of vascular infections in patients who have a pre-existing lesion such as an aneurysm, or vascular prosthesis even in the absence of a history of direct animal exposure.
Insights
Q fever, a Coxiella burnetii infection, can cause chronic vascular graft infections. This zoonotic disease should be considered in unexplained vascular infections, even without animal exposure history.
Area of Science:
- Infectious Diseases
- Vascular Surgery
- Microbiology
Background:
- Q fever is a zoonotic infection caused by Coxiella burnetii, typically transmitted via aerosols from livestock.
- Chronic Q fever develops in 1-5% of acute cases, potentially years after initial infection.
- Vascular graft infections are serious complications requiring prompt diagnosis and treatment.
Observation:
- A 61-year-old man presented with recurrent fever and suspected vascular graft infection.
- Diagnostic imaging suggested a graft infection, and serological tests showed high Coxiella burnetii antibody titers.
- PCR on the explanted graft confirmed the presence of Coxiella burnetii.
Findings:
- The case highlights a chronic vascular graft infection caused by Coxiella burnetii.
- The patient had no history of direct animal exposure, challenging typical transmission assumptions.
- High IgG antibody titers and positive PCR confirmed the diagnosis.
Implications:
- Q fever should be included in the differential diagnosis for vascular infections, particularly in patients with prosthetic material.
- This case underscores the importance of considering zoonotic infections in unexplained graft failures.
- Early recognition and appropriate antibiotic therapy are crucial for managing Coxiella burnetii vascular infections.
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