{"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":1793892648192,"version":"4.8.0"},"reference-count":6,"publisher":"BMJ","issue":"10","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,10,11]]},"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:p>Our case highlights an atypical presentation of <jats:italic>Coxiella burnetii<\/jats:italic> endocarditis with acute ischaemic stroke in a male patient in his 60s. The patient had undergone a congenital bicuspid aortic valve replacement with a bioprosthetic valve and an ascending aortic root graft with a pacemaker. He experienced intermittent fevers, chills and malaise over 15 months leading up to his presentation. During our diagnostic process, we used the newly developed Karius test, which detects microbial cell-free DNA in the patient\u2019s serum. The patient was treated with doxycycline and hydroxychloroquine for 24 months along with surgical removal and replacement of his aortic valve and graft. Our case underscores the utility of the Karius test and the essential role of neurology in the multidisciplinary team.<\/jats:p>","DOI":"10.1136\/bcr-2024-263020","type":"journal-article","created":{"date-parts":[[2024,10,30]],"date-time":"2024-10-30T11:36:03Z","timestamp":1730288163000},"page":"e263020","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Karius testing in the identification of <i>Coxiella burnetii<\/i> infective endocarditis presenting with acute ischaemic stroke"],"prefix":"10.1136","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-0350-2900","authenticated-orcid":false,"given":"Michael James","family":"Smith","sequence":"first","affiliation":[{"name":"School of Medicine, Creighton University Phoenix Regional Campus, Phoenix, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Connor","family":"Welsh","sequence":"additional","affiliation":[{"name":"Barrow Neurological Institute, Phoenix, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Gonzalez","sequence":"additional","affiliation":[{"name":"Barrow Neurological Institute, Phoenix, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David Z","family":"Wang","sequence":"additional","affiliation":[{"name":"Barrow Neurological Institute, Phoenix, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,10,30]]},"reference":[{"key":"2025082800045963000_17.10.e263020.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.vetmic.2009.07.016"},{"key":"2025082800045963000_17.10.e263020.2","first-page":"781","article-title":"Q fever endocarditis: a case report and review of the literature","volume":"22","author":"Deyell","year":"2006","journal-title":"Can J Cardiol"},{"key":"2025082800045963000_17.10.e263020.3","first-page":"1","article-title":"Diagnosis and management of Q fever--United States, 2013: recommendations from CDC and the Q Fever Working Group","volume":"62","author":"Anderson","year":"2013","journal-title":"MMWR Recomm Rep"},{"key":"2025082800045963000_17.10.e263020.4","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.12.4.518"},{"key":"2025082800045963000_17.10.e263020.5","doi-asserted-by":"crossref","first-page":"e1492","DOI":"10.1093\/cid\/ciac426","article-title":"Microbial Cell-Free DNA Identifies the Causative Pathogen in Infective Endocarditis and Remains Detectable Longer Than Conventional Blood Culture in Patients with Prior Antibiotic Therapy","volume":"76","author":"Eichenberger","year":"2023","journal-title":"Clin Infect Dis"},{"key":"2025082800045963000_17.10.e263020.6","first-page":"291","article-title":"A Quality Improvement Initiative: Developing a Multi-Disciplinary Team for Infective Endocarditis","volume":"116","author":"Regunath","year":"2019","journal-title":"Mo Med"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2024-263020","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T07:05:10Z","timestamp":1756364710000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2024-263020"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10]]},"references-count":6,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2024,10,30]]},"published-print":{"date-parts":[[2024,10]]}},"alternative-id":["10.1136\/bcr-2024-263020"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2024-263020","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10]]}}}