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Vector Borne Infectious Diseases / Bartonella Species Infections Research · Journal article
Open Forum Infectious Diseases · August 20, 2026
Early or partial results. Treat as a signal, not a conclusion.
This is a retrospective single-centre case series describing 33 patients with chronic Q fever, predominantly with cardiovascular involvement. It documents diagnostic delay (median 99 days), treatment patterns (75% doxycycline plus hydroxychloroquine), and a low mortality rate (6%), but cannot establish causality, generalizability, or comparative effectiveness.
Retrospective cohort study. Patients with chronic Q fever (clinical evidence plus confirmatory serology or PCR) managed at Mayo Clinic tertiary care centre between 2007 and 2023.. Intervention: Chronic Q fever cases managed with standard antimicrobial and surgical therapies (predominantly doxycycline and hydroxychloroquine; 42% underwent surgical intervention). n = 33. Mayo Clinic (single tertiary care centre, United States).
Median diagnostic delay was 99 days; 11.4 days elapsed between Infectious Diseases evaluation and diagnosis (n=33) Prosthetic valve endocarditis occurred in 14 patients (42%) and vascular graft infection in 9 (27%) Animal exposure reported in 17 patients (52%); 8 patients (24%) had no identifiable exposure
Mortality attributable to chronic Q fever was 6% (n=2 deaths)
This series illustrates the real-world diagnostic and management burden of chronic Q fever in a tertiary centre, including prolonged diagnostic delay and high rates of cardiovascular involvement requiring surgery. Clinicians should be aware of diagnostic challenges and consider early specialist involvement, but this single-centre retrospective report cannot guide treatment decisions or predict outcomes in other settings.
Retrospective single-centre case series with modest sample size and no comparator; provides descriptive epidemiology and outcomes but lacks the design rigour to support generalizable clinical recommendations.
As stated by the source record.
Quoted from the source exactly as published.
This series illustrates the real-world diagnostic and management burden of chronic Q fever in a tertiary centre, including prolonged diagnostic delay and high rates of cardiovascular involvement requiring surgery. Clinicians should be aware of diagnostic challenges and consider early specialist involvement, but this single-centre retrospective report cannot guide treatment decisions or predict outcomes in other settings.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Abstract Background Chronic Q fever, caused by Coxiella burnetii, presents significant diagnostic and management challenges due to its variable presentation and high morbidity, especially among patients with underlying cardiac or vascular disease. In the United States, cases are rising, often without identifiable exposures, and diagnostic delays remain common. Methods We conducted a retrospective cohort study of chronic Q fever cases at the Mayo Clinic from 2007 to 2023. Patients with clinical evidence and a phase I IgG titer ≥1:1024 and/or positive PCR for C. burnetii were included. Data were abstracted from electronic health records, including demographics, exposures, clinical manifestations, diagnostics, treatments, and outcomes. Statistical analyses assessed factors influencing diagnostic delay and treatment response. Results We identified 33 patients with chronic Q fever (median age 56; 88% male). Median time to diagnosis was 99 days with 11.4 days between Infectious Diseases (ID) evaluation and diagnosis. Animal exposure was reported in 17 patients (52%), while eight (24%) had no identifiable exposure. Patients primarily presented with prosthetic valve endocarditis (n=14, 42%), or vascular graft infection (n=9, 27%). The majority were treated with doxycycline and hydroxychloroquine (n=25, 75%) and 14 patients (42%) required surgical intervention. Mortality attributable to chronic Q fever was 6% (n=2). Conclusions Chronic Q fever remains under-recognized, with substantial diagnostic delays prior to treatment. Cardiovascular infection predominates, and surgical intervention is often required despite prolonged antimicrobial therapy. Early specialist evaluation and standardized diagnostic pathways may improve outcomes.
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