Chest Infections |

Pulmonary Manifestations of Q Fever: The 14-Year Mayo Clinic Experience FREE TO VIEW

Diana Kelm, MD; Darin White, MD; Hind Fadel, MD; Jay Ryu, MD; Fabien Maldonado, MD; Misbah Baqir, MBBS
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Mayo Clinic Rochester, Rochester, MN

Chest. 2015;148(4_MeetingAbstracts):128A. doi:10.1378/chest.2249786
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SESSION TITLE: Chest infections Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Lung involvement in acute Q fever is often nonspecific and can mimic the appearance of atypical pneumonia or present as multiple rounded opacities. Chronic Q fever (infection ≥ 6 months) often presents as endocarditis, aneurysmal or vascular graft infections or osteomyelitis. Involvement of the lung with chronic Q fever is rare though there are a few reported cases of pseudotumor and chronic pulmonary fibrosis. The aim of this study was to evaluate the pulmonary manifestations of Q fever.

METHODS: We conducted a retrospective cohort study of patients with a diagnosis of Q fever at Mayo Clinic Rochester. A total of 69 patients seen between July 2001 and January 2015 at our medical center were identified. Thirty-three patients were excluded: 22 patients did not meet serologic criteria for Q fever and 11 patients did not have imaging available for current review from the time of initial diagnosis, leaving 36 patients in this study. Descriptive analysis was conducted using JMP software.

RESULTS: The median age was 57 years (IQR 43-61), 82% from the Midwest, 19% with history of chronic lung disease, and only 25% worked in farming or with animals. Twenty cases (56%) had a diagnosis of acute Q fever, 4 of who progressed to chronic Q fever. Respiratory symptoms and smoking history were noted in 4 (11%) and 19 (53%) patients, respectively. Six (15%) patients had imaging compatible with Q fever. Three patients with acute Q fever had pulmonary manifestations that included 2 with consolidation, 2 with hilar lymphadenopathy, and 2 with pleural effusion. For those with chronic Q fever, one patient had graft involvement as seen on PET scan and two had an aortic pseudoaneurysm, one of which resulted in a right upper lobe lung mass. No patient had findings of fibrosis associated with Q fever.

CONCLUSIONS: Our results show that pulmonary symptomatology and chest imaging such as consolidation, lymphadenopathy, or lung mass seen with Q fever is uncommon. However, it can occur in both acute and chronic Q fever and should be considered in the appropriate clinical context.

CLINICAL IMPLICATIONS: Pulmonary manifestations are uncommon in Q fever but include consolidation, lymphadenopathy, pleural effusion, and vascular complications.

DISCLOSURE: The following authors have nothing to disclose: Diana Kelm, Darin White, Hind Fadel, Jay Ryu, Fabien Maldonado, Misbah Baqir

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