Cholecystitis associated with Q fever: case report and systematic review

Area of Science:

• Infectious Diseases
• Gastroenterology
• Immunology

Background:

• Coxiella burnetii is an underrecognized cause of acalculous cholecystitis.
• A dose-dependent association with IgG anticardiolipin has been identified.
• Long-term management and complications of Q fever-associated cholecystitis require further investigation.

Purpose of the Study:

• To describe a case of Coxiella burnetii cholecystitis in an endemic area.
• To conduct a systematic review of C. burnetii cholecystitis cases associated with Q fever.
• To highlight diagnostic and therapeutic strategies for C. burnetii cholecystitis.

Main Methods:

• Surgical case description from an endemic area.
• Systematic review of C. burnetii cholecystitis cases.
• Analysis of patient data including demographics, symptoms, diagnostic tests, and treatment outcomes.

Main Results:

• Twenty-seven patients were included, with 11.1% being children.
• Most cases occurred during acute Q fever; one patient developed chronic cholecystitis.
• Gallbladder PCR confirmed C. burnetii in 100% of tested cases; only 11.1% were calculous.
• Typical presentation includes acalculous cholecystitis, flu-like illness, lupus anticoagulant, anticardiolipin antibodies, and thrombocytopenia.

Conclusions:

• Serology and PCR (blood, gallbladder biopsies) are crucial for diagnosing C. burnetii cholecystitis.
• An inflammatory and/or autoimmune mechanism is suspected.
• Doxycycline is the recommended first-line therapy; future studies should explore doxycycline and hydroxychloroquine for preventing chronic disease in antiphospholipid antibody-positive patients.