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Cholecystitis associated with Q fever: case report and systematic review
Aymery Stheme de Jubécourt1,2, Marie Hocquart3, Olivier Picaud3
1Institut Hospitalo-Universitaire Méditerranée Infection, 19-21 boulevard Jean Moulin, Marseille, 13005, France. aymery.Stheme-de-jubecourt@ap-hm.fr.
Background:
Coxiella burnetii is an underestimated cause of acalculous cholecystitis. Large studies recently allowed to identify a dose-dependent association with IgG anticardiolipin. The management and long-term complications of Q fever-associated cholecystitis remain to be determined.
Methods:
We describe a surgical case from Martigues, France, which is an endemic area and performed a systematic review of C. burnetii cholecystitis cases associated with Q Fever.
Results:
Twenty-seven patients were included, including 3 (11.1%) children. All cases were reported during acute Q fever, followed by recurrent pancreatitis and chronic cholecystitis in 1 (3.7%) case. Two (2/2, 100%) were proven by a positive PCR on gallbladder but immunohistochemistry was negative in all cases. Only 3 (11.1%) cases were calculous. Coxiella burnetii cholecystitis is atypic because it is acalculous, with a flu-like syndrome, lupus anticoagulant, anticardiolipin antibodies and thrombocytopaenia.
Conclusions:
Serology and PCR from blood and gallbladder biopsies are key to the aetiological diagnosis of C. burnetii cholecystitis. Inflammatory and/or autoimmune mechanism is suspected. Doxycycline remains the first-line therapy. Future prospective studies should determine whether treatment with doxycycline and hydroxychloroquine can prevent the chronic evolution of the disease in patients who initially present with antiphospholipid antibodies.
Insights
Coxiella burnetii causes acalculous cholecystitis, often linked to Q fever. Diagnosis relies on serology and PCR, with doxycycline as primary treatment for this infection.
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.
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