{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T15:30:48Z","timestamp":1793892648173,"version":"4.8.0"},"reference-count":70,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n \n Q fever remains widespread throughout the world; the disease is serious and causes outbreaks and deaths when complications are not detected. The diagnosis of Q fever requires the demonstration of the presence of\n Coxiella burnetii<\/jats:italic>\n and the identification of an organic lesion.\n <\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To describe the hitherto neglected clinical characteristics of Q fever and identifying risk factors for complications and death.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n \n This prospective cohort study conducted from January 1, 1991, through December 31, 2016, included patients treated at the French National Reference Center for Q fever with serologic findings positive for\n C burnetii<\/jats:italic>\n and clinical data consistent with\n C burnetii<\/jats:italic>\n infection. Clinical data were prospectively collected by telephone. Patients with unavailable clinical data or an unidentified infectious focus were excluded.\n <\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Q fever complications and mortality.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of the 180\u202f483 patients undergoing testing, 2918 had positive findings for\n C burnetii<\/jats:italic>\n and 2434 (68.8% men) presented with clinical data consistent with a\n C burnetii<\/jats:italic>\n infection. Mean (SD) age was 51.8 (17.4) years, and the ratio of men to women was 2.2. At the time of inclusion, 1806 patients presented with acute Q fever, including 138 with acute Q fever that progressed to persistent\n C burnetii<\/jats:italic>\n infection, and 766 had persistent focalized\n C burnetii<\/jats:italic>\n infection. Rare and hitherto neglected foci of infections included lymphadenitis (97 [4.0%]), acute Q fever endocarditis (50 [2.1%]), hemophagocytic syndrome (9 [0.4%]), and alithiasic cholecystitis (11 [0.4%]). Vascular infection (hazard ratio [HR],\u20093.1; 95% CI, 1.7-5.7;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) and endocarditis (HR,\u20092.4; 95% CI, 1.1-5.1;\n P<\/jats:italic>\n \u2009=\u2009.02) were associated with an increased risk of death. Independent indicators of lymphoma were lymphadenitis (HR,\u200977.4; 95% CI, 21.2-281.8;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) and hemophagocytic syndrome (HR,\u200919.1; 95% CI, 3.4-108.6;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). The presence of anticardiolipin antibodies during acute Q fever has been associated with several complications, including hepatitis, cholecystitis, endocarditis, thrombosis, hemophagocytic syndrome, meningitis, and progression to persistent endocarditis.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n \n Previously neglected foci of\n C burnetii<\/jats:italic>\n infection include the lymphatic system (ie, bone marrow, lymphadenitis) with a risk of lymphoma. Cardiovascular infections were the main fatal complications, highlighting the importance of routine screening for valvular heart disease and vascular anomalies during acute Q fever. Routine screening for anticardiolopin antibodies during acute Q fever can help prevent complications. Positron emission tomographic scanning could be proposed for all patients with suspected persistent focused infection to rapidly diagnose vascular and lymphatic infections associated with death and lymphoma, respectively.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2018.1580","type":"journal-article","created":{"date-parts":[[2018,10,26]],"date-time":"2018-10-26T15:14:49Z","timestamp":1540566889000},"page":"e181580","source":"Crossref","is-referenced-by-count":137,"title":["Clinical Features and Complications of\n Coxiella burnetii<\/i>\n Infections From the French National Reference Center for Q Fever"],"prefix":"10.1001","volume":"1","author":[{"given":"Cl\u00e9a","family":"Melenotte","sequence":"first","affiliation":[{"name":"Aix-Marseille University, Institut de Recherche pour le D\u00e9veloppement (IRD), Assistance Publique H\u00f4pitaux de Marseille (APHM), Microbes, Evolution, Phylog\u00e9nie et Infections, IHU (Institut Hospitalo-Universitaire)\u2013M\u00e9diterran\u00e9e Infection, Marseille, France"},{"name":"French Reference Center for the Diagnosis and Study of Rickettsioses, Q Fever and Bartonelloses, IHU\u2013M\u00e9diterran\u00e9e Infection, Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cam\u00e9lia","family":"Protopopescu","sequence":"additional","affiliation":[{"name":"Observatoire R\u00e9gional de la Sant\u00e9 Provence-Alpes-C\u00f4te d\u2019Azur, Marseille, France"},{"name":"Aix-Marseille Universit\u00e9, Institut National de la Sant\u00e9 et de la Recherche Medicale, IRD, Sciences Economiques et Sociales de la Sant\u00e9 et Traitement de l\u2019Information M\u00e9dicale, Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthieu","family":"Million","sequence":"additional","affiliation":[{"name":"Aix-Marseille University, Institut de Recherche pour le D\u00e9veloppement (IRD), Assistance Publique H\u00f4pitaux de Marseille (APHM), Microbes, Evolution, Phylog\u00e9nie et Infections, IHU (Institut Hospitalo-Universitaire)\u2013M\u00e9diterran\u00e9e Infection, Marseille, France"},{"name":"French Reference Center for the Diagnosis and Study of Rickettsioses, Q Fever and Bartonelloses, IHU\u2013M\u00e9diterran\u00e9e Infection, Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Edouard","sequence":"additional","affiliation":[{"name":"Aix-Marseille University, Institut de Recherche pour le D\u00e9veloppement (IRD), Assistance Publique H\u00f4pitaux de Marseille (APHM), Microbes, Evolution, Phylog\u00e9nie et Infections, IHU (Institut Hospitalo-Universitaire)\u2013M\u00e9diterran\u00e9e Infection, Marseille, France"},{"name":"French Reference Center for the Diagnosis and Study of Rickettsioses, Q Fever and Bartonelloses, IHU\u2013M\u00e9diterran\u00e9e Infection, Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. Patrizia","family":"Carrieri","sequence":"additional","affiliation":[{"name":"Aix-Marseille University, Institut de Recherche pour le D\u00e9veloppement (IRD), Assistance Publique H\u00f4pitaux de Marseille (APHM), Microbes, Evolution, Phylog\u00e9nie et Infections, IHU (Institut Hospitalo-Universitaire)\u2013M\u00e9diterran\u00e9e Infection, Marseille, France"},{"name":"Aix-Marseille Universit\u00e9, Institut National de la Sant\u00e9 et de la Recherche Medicale, IRD, Sciences Economiques et Sociales de la Sant\u00e9 et Traitement de l\u2019Information M\u00e9dicale, Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carole","family":"Eldin","sequence":"additional","affiliation":[{"name":"Aix-Marseille University, Institut de Recherche pour le D\u00e9veloppement (IRD), Assistance Publique H\u00f4pitaux de Marseille (APHM), Microbes, Evolution, Phylog\u00e9nie et Infections, IHU (Institut Hospitalo-Universitaire)\u2013M\u00e9diterran\u00e9e Infection, Marseille, France"},{"name":"French Reference Center for the Diagnosis and Study of Rickettsioses, Q Fever and Bartonelloses, IHU\u2013M\u00e9diterran\u00e9e Infection, Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanouil","family":"Angelakis","sequence":"additional","affiliation":[{"name":"Aix-Marseille University, Institut de Recherche pour le D\u00e9veloppement (IRD), Assistance Publique H\u00f4pitaux de Marseille (APHM), Microbes, Evolution, Phylog\u00e9nie et Infections, IHU (Institut Hospitalo-Universitaire)\u2013M\u00e9diterran\u00e9e Infection, Marseille, France"},{"name":"French Reference Center for the Diagnosis and Study of Rickettsioses, Q Fever and Bartonelloses, IHU\u2013M\u00e9diterran\u00e9e Infection, Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F\u00e9lix","family":"Djossou","sequence":"additional","affiliation":[{"name":"Unit\u00e9 de Maladies Infectieuses et Tropicales, Centre Hospitalier Andr\u00e9 Rosemon, Cayenne, Guyane Fran\u00e7aise"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathalie","family":"Bardin","sequence":"additional","affiliation":[{"name":"Aix-Marseille University, Institut de Recherche pour le D\u00e9veloppement (IRD), Assistance Publique H\u00f4pitaux de Marseille (APHM), Microbes, Evolution, Phylog\u00e9nie et Infections, IHU (Institut Hospitalo-Universitaire)\u2013M\u00e9diterran\u00e9e Infection, Marseille, France"},{"name":"Immunology Laboratory, APHM, Centre Hospitalier Universitaire Conception, Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre-Edouard","family":"Fournier","sequence":"additional","affiliation":[{"name":"Aix-Marseille University, Institut de Recherche pour le D\u00e9veloppement (IRD), Assistance Publique H\u00f4pitaux de Marseille (APHM), Microbes, Evolution, Phylog\u00e9nie et Infections, IHU (Institut Hospitalo-Universitaire)\u2013M\u00e9diterran\u00e9e Infection, Marseille, France"},{"name":"French Reference Center for the Diagnosis and Study of Rickettsioses, Q Fever and Bartonelloses, IHU\u2013M\u00e9diterran\u00e9e Infection, Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Louis","family":"M\u00e8ge","sequence":"additional","affiliation":[{"name":"Aix-Marseille University, Institut de Recherche pour le D\u00e9veloppement (IRD), Assistance Publique H\u00f4pitaux de Marseille (APHM), Microbes, Evolution, Phylog\u00e9nie et Infections, IHU (Institut Hospitalo-Universitaire)\u2013M\u00e9diterran\u00e9e Infection, Marseille, France"},{"name":"Immunology Laboratory, APHM, Centre Hospitalier Universitaire Conception, Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Didier","family":"Raoult","sequence":"additional","affiliation":[{"name":"Aix-Marseille University, Institut de Recherche pour le D\u00e9veloppement (IRD), Assistance Publique H\u00f4pitaux de Marseille (APHM), Microbes, Evolution, Phylog\u00e9nie et Infections, IHU (Institut Hospitalo-Universitaire)\u2013M\u00e9diterran\u00e9e Infection, Marseille, France"},{"name":"French Reference Center for the Diagnosis and Study of Rickettsioses, Q Fever and Bartonelloses, IHU\u2013M\u00e9diterran\u00e9e Infection, Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2018,8,24]]},"reference":[{"issue":"6","key":"zoi180098r1","doi-asserted-by":"publisher","first-page":"1054","DOI":"10.1093\/cid\/cix469","article-title":"Q fever: confusion between chronic infection and chronic fatigue.","volume":"65","author":"Raoult","year":"2017","journal-title":"Clin Infect Dis"},{"issue":"1","key":"zoi180098r2","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1128\/CMR.00045-16","article-title":"From Q fever to Coxiella burnetii infection: a paradigm change.","volume":"30","author":"Eldin","year":"2017","journal-title":"Clin Microbiol 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