A Case of Q fever: What Does the South Dakota Clinician Need to Know?

Q fever is a reportable, zoonotic infection caused by Coxiella burnetii. It can present as either an acute or chronic infection. Acute Q fever is frequently asymptomatic or presents with nonspecific symptoms, making the diagnosis challenging. In the chronic state it will manifest as localized infection such as endocarditis, which is the most common. South Dakota has the highest incidence of Q fever in the U.S. with 12.4 cases per million people. We present a case of a patient in their 50s with mild hepatitis and persistent fevers and eventually was diagnosed with Q fever. The patient had no known exposures. The Q fever was diagnosed using Karius testing, liver biopsy, and serology. The patient was treated with doxycycline and improved. This case highlights diagnostic challenges and management considerations for South Dakota clinicians.