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Tissue samples of the aneurysmal abdominal aortic wall from seven patients with chronic <jats:styled-content style=\"fixed-case\">Q<\/jats:styled-content> fever and 15 patients without evidence of <jats:styled-content style=\"fixed-case\">Q<\/jats:styled-content> fever infection were analysed and compared. Chronic <jats:styled-content style=\"fixed-case\">Q<\/jats:styled-content> fever was diagnosed using serology and tissue <jats:styled-content style=\"fixed-case\">PCR<\/jats:styled-content> analysis. Histological sections were stained using haematoxylin and eosin staining, Elastica van Gieson staining and immunohistochemical staining for macrophages (<jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>68), <jats:styled-content style=\"fixed-case\">T<\/jats:styled-content> lymphocytes (<jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>3), T lymphocyte subsets (CD4 and CD8) and <jats:styled-content style=\"fixed-case\">B<\/jats:styled-content> lymphocytes (<jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>20). Samples were scored by one pathologist, blinded for <jats:styled-content style=\"fixed-case\">Q<\/jats:styled-content> fever status, using a standard score form. Seven tissue samples from patients with chronic <jats:styled-content style=\"fixed-case\">Q<\/jats:styled-content> fever and 15 tissue samples from patients without <jats:styled-content style=\"fixed-case\">Q<\/jats:styled-content> fever were collected. Four of seven chronic <jats:styled-content style=\"fixed-case\">Q<\/jats:styled-content> fever samples showed a necrotizing granulomatous response of the vascular wall, which was characterized by necrotic core of the arteriosclerotic plaque (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.005) and a presence of high numbers of macrophages in the adventitia (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.007) distributed in typical palisading formation (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.005) and surrounded by the presence of <jats:styled-content style=\"fixed-case\">high numbers of T<\/jats:styled-content> lymphocytes located diffusely in media and adventitia. Necrotizing granulomas are a histological finding in the <jats:italic><jats:styled-content style=\"fixed-case\">C<\/jats:styled-content>.\u00a0burnetii<\/jats:italic>\u2010infected aneurysmal abdominal aortic wall. Chronic <jats:styled-content style=\"fixed-case\">Q<\/jats:styled-content> fever should be included in the list of infectious diseases with necrotizing granulomatous response, such as tuberculosis, cat scratch disease and syphilis.<\/jats:p>","DOI":"10.1111\/iep.12086","type":"journal-article","created":{"date-parts":[[2014,6,23]],"date-time":"2014-06-23T16:36:27Z","timestamp":1403541387000},"page":"282-289","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Histological characteristics of the abdominal aortic wall in patients with vascular chronic <scp>Q<\/scp> fever"],"prefix":"10.1111","volume":"95","author":[{"given":"Julia C. J. P.","family":"Hagenaars","sequence":"first","affiliation":[{"name":"Department of Surgery Jeroen Bosch Hospital \u2018s\u2010Hertogenbosch the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier H. 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