{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T13:31:59Z","timestamp":1789651919037,"version":"4.0.0"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,6,17]],"date-time":"2024-06-17T00:00:00Z","timestamp":1718582400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,6,17]],"date-time":"2024-06-17T00:00:00Z","timestamp":1718582400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Infect Dis"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Q fever, caused by the zoonotic pathogen Coxiella burnetii, exhibits a worldwide prevalence. In China, Q fever is not recognized as a notifiable disease, and the disease is overlooked and underestimated in clinical practice, leading to diagnostic challenges.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>We present a case series of three patients diagnosed with persistent Q fever between 2022 and 2023. The average age of our three cases was 63.33 years old, consisting of two males and one female. The medical history of the individuals included previous valve replacement, aneurysm followed by aortic stent-graft placement and prosthetic hip joint replacement. At the onset of the disease, only one case exhibited acute fever, while the remaining two cases were devoid of any acute symptoms. The etiology was initially overlooked until metagenomic next-generation sequencing test identified Coxiella burnetii from the blood or biopsy samples. Delayed diagnosis was noted, with a duration ranging from three months to one year between the onset of the disease and its confirmation. The epidemiological history uncovered that none of the three cases had direct exposure to domestic animals or consumption of unpasteurized dairy products. Case 1 and 2 resided in urban areas, while Case 3 was a rural resident engaged in farming. All patients received combination therapy of doxycycline and hydroxychloroquine, and no recurrence of the disease was observed during the follow-up period.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Q fever is rarely diagnosed and reported in clinical practice in our country. We should be aware of persistent Q fever in high-risk population, even with unremarkable exposure history. Metagenomic next-generation sequencing holds great potential as a diagnostic tool for identifying rare and fastidious pathogens such as Coxiella burnetii.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12879-024-09484-w","type":"journal-article","created":{"date-parts":[[2024,6,17]],"date-time":"2024-06-17T08:02:18Z","timestamp":1718611338000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Delayed diagnosis of persistent Q fever: a case series from China"],"prefix":"10.1186","volume":"24","author":[{"given":"Shanshan","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ke","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gang","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,6,17]]},"reference":[{"issue":"3","key":"9484_CR1","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1016\/j.micinf.2019.09.001","volume":"22","author":"AL Dragan","year":"2020","unstructured":"Dragan AL, Voth DE. Coxiella burnetii: international pathogen of mystery. Microbes Infect. 2020;22(3):100\u201310.","journal-title":"Microbes Infect"},{"issue":"1","key":"9484_CR2","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1128\/CMR.00045-16","volume":"30","author":"C Eldin","year":"2017","unstructured":"Eldin C, M\u00e9lenotte C, Mediannikov O, Ghigo E, Million M, Edouard S, Mege J-L, Maurin M, Raoult D. From Q fever to Coxiella burnetii infection: a paradigm change. Clin Microbiol Rev. 2017;30(1):115\u201390.","journal-title":"Clin Microbiol Rev"},{"issue":"4","key":"9484_CR3","doi-asserted-by":"publisher","first-page":"e181580","DOI":"10.1001\/jamanetworkopen.2018.1580","volume":"1","author":"C Melenotte","year":"2018","unstructured":"Melenotte C, Protopopescu C, Million M, Edouard S, Carrieri MP, Eldin C, Angelakis E, Djossou F, Bardin N, Fournier PE, et al. Clinical features and complications of Coxiella burnetii infections from the French National Reference Center for Q Fever. 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The study was performaned in accordance with the Declaration of Helsinki and all methods were performed in accordance with the relevant guidelines and regulations. All the participants provided their informed consent to participate in this study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written Informed consent statements were obtained from all study participants for publication of identifiable information\/ images in open access journal.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"591"}}