{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:08:11Z","timestamp":1792786091334,"version":"4.5.0"},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"9","funder":[{"name":"Mayo Clinic Enterprise","id":[{"id":"https:\/\/ror.org\/02qp3tb03","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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 \u22651:1024 and\/or positive polymerase chain reaction 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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 evaluation and diagnosis. Animal exposure was reported in 17 patients (52%), while 8 (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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofag542","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T11:46:12Z","timestamp":1787226372000},"source":"Crossref","is-referenced-by-count":0,"title":["Retrospective Analysis of Chronic Q Fever Cases at a Tertiary Care Center From 2007 to 2023"],"prefix":"10.1093","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1730-5604","authenticated-orcid":false,"given":"Mitchell G","family":"Dumais","sequence":"first","affiliation":[{"name":"Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health , Bethesda, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0144-6720","authenticated-orcid":false,"given":"James F","family":"Howick V","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Mayo Clinic , Jacksonville, Florida ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1512-3770","authenticated-orcid":false,"given":"Sofia Molina","family":"Garcia","sequence":"additional","affiliation":[{"name":"Department of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic , Rochester, Minnesota ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4331-5259","authenticated-orcid":false,"given":"Said","family":"El Zein","sequence":"additional","affiliation":[{"name":"Department of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic , Rochester, Minnesota ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Abu Saleh","sequence":"additional","affiliation":[{"name":"Department of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic , Rochester, Minnesota ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,21]]},"reference":[{"issue":"RR-03","key":"2026091805323764900_ofag542-B1","first-page":"1","article-title":"Diagnosis and management of Q fever\u2013United States, 2013: recommendations from CDC and the Q Fever Working Group","volume":"62","author":"Anderson","year":"2013","journal-title":"MMWR Recomm Rep"},{"key":"2026091805323764900_ofag542-B2","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1111\/zph.12896","article-title":"Acute and chronic Q fever national surveillance\u2014United States, 2008\u20132017","volume":"69","author":"Cherry","year":"2022","journal-title":"Zoonoses Public Health"},{"key":"2026091805323764900_ofag542-B3","doi-asserted-by":"crossref","first-page":"1240","DOI":"10.1017\/S0950268818001395","article-title":"Q fever: an under-reported reportable communicable disease","volume":"146","author":"Kaufman","year":"2018","journal-title":"Epidemiol Infect"},{"key":"2026091805323764900_ofag542-B4","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1128\/CMR.12.4.518","article-title":"Q fever","volume":"12","author":"Maurin","year":"1999","journal-title":"Clin Microbiol Rev"},{"key":"2026091805323764900_ofag542-B5","doi-asserted-by":"crossref","first-page":"1390","DOI":"10.1016\/j.cmi.2018.11.023","article-title":"Chronic Q fever-related complications and mortality: data from a nationwide cohort","volume":"25","author":"van Roeden","year":"2019","journal-title":"Clin Microbiol Infect"},{"key":"2026091805323764900_ofag542-B6","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1017\/S0950268812001203","article-title":"Screening for Coxiella burnetii seroprevalence in chronic Q fever high-risk groups reveals the magnitude of the Dutch Q fever outbreak","volume":"141","author":"Kampschreur","year":"2013","journal-title":"Epidemiol Infect"},{"key":"2026091805323764900_ofag542-B7","doi-asserted-by":"crossref","first-page":"1476","DOI":"10.1093\/cid\/ciab476","article-title":"Still new chronic Q fever cases diagnosed 8 years after a large Q fever outbreak","volume":"73","author":"Buijs","year":"2021","journal-title":"Clin Infect Dis"},{"key":"2026091805323764900_ofag542-B8","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1097\/00005792-200003000-00005","article-title":"Q fever 1985\u20131998. Clinical and epidemiologic features of 1,383 infections","volume":"79","author":"Raoult","year":"2000","journal-title":"Medicine (Baltimore)"},{"key":"2026091805323764900_ofag542-B9","doi-asserted-by":"crossref","first-page":"e181580","DOI":"10.1001\/jamanetworkopen.2018.1580","article-title":"Clinical features and complications of Coxiella burnetii infections from the French National Reference Center for Q fever","volume":"1","author":"Melenotte","year":"2018","journal-title":"JAMA Netw Open"},{"key":"2026091805323764900_ofag542-B10","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1086\/313753","article-title":"Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis","volume":"30","author":"Li","year":"2000","journal-title":"Clin Infect Dis"},{"key":"2026091805323764900_ofag542-B11","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1093\/cid\/ciad271","article-title":"The 2023 Duke-International Society for Cardiovascular Infectious Diseases criteria for infective endocarditis: updating the modified Duke criteria","volume":"77","author":"Fowler","year":"2023","journal-title":"Clin Infect Dis"},{"key":"2026091805323764900_ofag542-B12","doi-asserted-by":"crossref","first-page":"ofae277","DOI":"10.1093\/ofid\/ofae277","article-title":"Acute Coxiella burnetii infection: a 10-year clinical experience at a tertiary care center in the United States","volume":"11","author":"El Zein","year":"2024","journal-title":"Open Forum Infect Dis"},{"key":"2026091805323764900_ofag542-B13","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research electronic data capture (REDCap)\u2014a metadata-driven methodology and workflow process for providing translational research informatics support","volume":"42","author":"Harris","year":"2009","journal-title":"J Biomed Inform"},{"key":"2026091805323764900_ofag542-B14","doi-asserted-by":"crossref","first-page":"103208","DOI":"10.1016\/j.jbi.2019.103208","article-title":"The REDCap consortium: building an international community of software platform partners","volume":"95","author":"Harris","year":"2019","journal-title":"J Biomed Inform"},{"key":"2026091805323764900_ofag542-B15","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1128\/CVI.00454-09","article-title":"Real-time PCR with serum samples is indispensable for early diagnosis of acute Q fever","volume":"17","author":"Schneeberger","year":"2010","journal-title":"Clin Vaccine Immunol"},{"key":"2026091805323764900_ofag542-B16","doi-asserted-by":"crossref","first-page":"1637","DOI":"10.1128\/JCM.03221-13","article-title":"Chronic Q fever in the Netherlands 5 years after the start of the Q fever epidemic: results from the Dutch chronic Q fever database","volume":"52","author":"Kampschreur","year":"2014","journal-title":"J Clin Microbiol"},{"key":"2026091805323764900_ofag542-B17","doi-asserted-by":"crossref","first-page":"1872","DOI":"10.1093\/cid\/cix702","article-title":"Surveillance for Q fever endocarditis in the United States, 1999\u20132015","volume":"65","author":"Straily","year":"2017","journal-title":"Clin Infect Dis"},{"key":"2026091805323764900_ofag542-B18","doi-asserted-by":"crossref","first-page":"1326","DOI":"10.1111\/imj.14447","article-title":"Acute kidney injury in acute Q fever","volume":"49","author":"Stewart","year":"2019","journal-title":"Intern Med J"},{"key":"2026091805323764900_ofag542-B19","doi-asserted-by":"crossref","first-page":"293","DOI":"10.5578\/mb.20239924","article-title":"[Q fever endocarditis-associated immune complex-mediated proliferative glomerulonephritis: fourth case from T\u00fcrkiye]","volume":"57","author":"Ismayilov","year":"2023","journal-title":"Mikrobiyol Bul"},{"key":"2026091805323764900_ofag542-B20","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1186\/s12882-024-03694-9","article-title":"Case report: membranoproliferative glomerulonephritis associated with Q fever causing chronic endocarditis","volume":"25","author":"Loyen","year":"2024","journal-title":"BMC Nephrol"},{"key":"2026091805323764900_ofag542-B21","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.epidem.2015.07.001","article-title":"Kinetics of antibody response to Coxiella burnetii infection (Q fever): estimation of the seroresponse onset from antibody levels","volume":"13","author":"Wielders","year":"2015","journal-title":"Epidemics"},{"key":"2026091805323764900_ofag542-B22","doi-asserted-by":"crossref","first-page":"1273","DOI":"10.1016\/j.cmi.2021.03.016","article-title":"The prognostic value of serological titres for clinical outcomes during treatment and follow-up of patients with chronic Q fever","volume":"27","author":"Buijs","year":"2021","journal-title":"Clin Microbiol Infect"}],"container-title":["Open Forum Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ofid\/advance-article-pdf\/doi\/10.1093\/ofid\/ofag542\/70749953\/ofag542.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/13\/9\/ofag542\/70749953\/ofag542.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/13\/9\/ofag542\/70749953\/ofag542.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T09:33:27Z","timestamp":1789724007000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ofid\/article\/doi\/10.1093\/ofid\/ofag542\/8767660"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,21]]},"references-count":22,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ofid\/ofag542","relation":{},"ISSN":["2328-8957"],"issn-type":[{"value":"2328-8957","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,9]]},"published":{"date-parts":[[2026,8,21]]},"article-number":"ofag542"}}