{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T03:15:32Z","timestamp":1771643732928,"version":"3.50.1"},"reference-count":38,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,7,3]]},"abstract":"<jats:p>Query fever (Q fever), caused by <jats:italic>Coxiella burnetii<\/jats:italic>, was first described in southern California in 1947. It was found to be endemic and enzoonotic to the region and associated with exposure to livestock. We describe a series of 20 patients diagnosed with Q fever at a Veterans Affairs hospital in southern California, with the aim of contributing toward the understanding of Q fever in this region. Demographics, laboratory data, diagnostic imaging, risk factors, and treatment regimens were collected via a retrospective chart review of patients diagnosed with Q fever at our institution between 2000 and 2016. Cases were categorized as acute or chronic and confirmed or probable. The majority presented with an acute febrile illness (90%). There was a delay in ordering diagnostic serology from the time of symptom onset (acute cases, average 31.9 days; chronic cases, average 63 days), and 15% progressed from acute to chronic infection. Of the chronic cases, 22.2% had endocarditis, 22.2% had endovascular infection, and 11.1% had both endocarditis and endovascular infection. The geographic distribution revealed that 20% resided in rural areas. Of the cases of Q fever that died, death attributed to Q fever was associated with an average diagnostic delay of 65.5 days. Acute Q fever is underreported in this region largely because of its often nonspecific clinical presentation.<\/jats:p>","DOI":"10.4269\/ajtmh.18-0283","type":"journal-article","created":{"date-parts":[[2019,5,21]],"date-time":"2019-05-21T07:01:11Z","timestamp":1558422071000},"page":"33-39","source":"Crossref","is-referenced-by-count":13,"title":["Q Fever in Southern California: a Case Series of 20 Patients from a VA Medical Center"],"prefix":"10.4269","volume":"101","author":[{"given":"Christine M.","family":"Akamine","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Loma Linda University Health, Loma Linda, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mario L.","family":"Perez","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Kaiser Permanente Fontana Medical Center, Fontana, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jea Hyun","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Kaiser Permanente Fontana Medical Center, Fontana, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael B.","family":"Ing","sequence":"additional","affiliation":[{"name":"Infectious Diseases Section, Veterans Affairs Loma Linda Healthcare System, Loma Linda, California"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","author":"Anderson","year":"2013"},{"key":"b2","series-title":"Emerg Infect Dis","first-page":"1183","article-title":"Chronic Q fever diagnosis\u2014consensus guideline versus expert opinion","volume":"21","author":"Kampschreur","year":"2015"},{"key":"b3","series-title":"Clin Infect Dis","first-page":"489","article-title":"Q fever","volume":"20","author":"Raoult","year":"1995"},{"key":"b4","series-title":"Foodborne Pathog Dis","first-page":"1453","article-title":"Detection of Coxiella burnetii in commercially available raw milk from the United States","volume":"7","author":"Loftis","year":"2010"},{"key":"b5","series-title":"Public Health Rep","first-page":"541","article-title":"Q fever studies in southern California; IX. 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Recovery of Coxiella burnetii from the air of premises harboring infected goats","volume":"54","author":"Lennette","year":"1951"},{"key":"b8","series-title":"Mayo Clin Proc","first-page":"574","article-title":"Q fever: epidemiology, diagnosis, and treatment","volume":"83","author":"Hartzell","year":"2008"},{"key":"b9","series-title":"Clin Infect Dis","first-page":"399","article-title":"Sexually transmitted Q fever","volume":"33","author":"Milazzo","year":"2001"},{"key":"b10","series-title":"Clin Infect Dis","first-page":"1087","article-title":"Possible sexual transmission of Q fever among humans","volume":"22","author":"Kruszewska","year":"1996"},{"key":"b11","series-title":"Vector Borne Zoonotic Dis","first-page":"179","article-title":"Q fever in humans and animals in the United States","volume":"2","author":"McQuiston","year":"2002"},{"key":"b12","series-title":"Public Health Rep","first-page":"1483","article-title":"Q fever studies in southern California; occurrence of Coxiella burnetii in the spinose ear tick, Otobius megnini","volume":"63","author":"Jellison","year":"1948"},{"key":"b13","series-title":"Am J Trop Med Hyg","first-page":"247","article-title":"Q fever in the United States: summary of case reports from two national surveillance systems, 2000\u20132012","volume":"92","author":"Dahlgren","year":"2015"},{"key":"b14","series-title":"Rev Infect Dis","first-page":"790","article-title":"\u201cQ\u201d fever, a new fever entity: clinical features, diagnosis and laboratory investigation","volume":"5","author":"Derrick","year":"1983"},{"key":"b15","series-title":"Calif Med","first-page":"89","article-title":"Q fever in artesia, California","volume":"69","author":"Young","year":"1948"},{"key":"b16","series-title":"Public Health Rep","first-page":"41","article-title":"Q fever studies in southern California; an epidemiological study of 300 cases","volume":"64","author":"Beck","year":"1949"},{"key":"b17","series-title":"AMA Arch Intern Med","first-page":"155","article-title":"Q fever in California. VII. Clinical features in one hundred eighty cases","volume":"88","author":"Clark","year":"1951"},{"key":"b18","series-title":"Am J Hyg","first-page":"1","article-title":"Q fever in California. V. Serologic survey of sheep, goats and cattle in three epidemiologic categories, from several geographic areas","volume":"54","author":"Lennette","year":"1951"},{"key":"b19","series-title":"Calif Med","first-page":"12","article-title":"Q fever in Los Angeles County. Serological survey of human and bovine populations","volume":"114","author":"Gross","year":"1971"},{"key":"b20","series-title":"Am J Trop Med Hyg","first-page":"29","article-title":"Q fever in the southern California desert: epidemiology, clinical presentation and treatment","volume":"75","author":"Cone","year":"2006"},{"key":"b21","series-title":"National Notifiable Diseases Surveillance System (NNDSS)","author":"Q Fever 2009 Case Definition","year":"2009"},{"key":"b22","series-title":"Am J Trop Med Hyg","first-page":"244","article-title":"Q fever is underestimated in the United States: a comparison of fatal Q fever cases from two national reporting systems","volume":"92","author":"Dahlgren","year":"2015"},{"key":"b23","series-title":"Clin Infect Dis","first-page":"836","article-title":"Evolution from acute Q fever to endocarditis is associated with underlying valvulopathy and age and can be prevented by prolonged antibiotic treatment","volume":"57","author":"Million","year":"2013"},{"key":"b24","series-title":"Clin Infect Dis","first-page":"1337","article-title":"From acute Q fever to endocarditis: serological follow-up strategy","volume":"44","author":"Landais","year":"2007"},{"key":"b25","series-title":"Neth J Med","first-page":"382","article-title":"Q fever in The Netherlands from 2007 to 2010","volume":"68","author":"Delsing","year":"2010"},{"key":"b26","author":"Ratcliffe","year":"2016"},{"key":"b27","series-title":"Ned Tijdschr Geneeskd","first-page":"A1845","article-title":"[Three years of Q fever in The Netherlands: faster diagnosis]","volume":"154","author":"van der Hoek","year":"2010"},{"key":"b28","series-title":"Am J Trop Med Hyg","first-page":"691","article-title":"Seroprevalence of Q fever in the United States, 2003\u20132004","volume":"81","author":"Anderson","year":"2009"},{"key":"b29","series-title":"Epidemiol Infect","first-page":"1240","article-title":"Q fever: an under-reported reportable communicable disease","volume":"146","author":"Kaufman","year":"2018"},{"key":"b30","series-title":"Epidemiology and Statistics|Q Fever [Internet]","author":"CDC","year":"2017"},{"key":"b31","series-title":"Clin Microbiol Rev","first-page":"115","article-title":"From Q fever to Coxiella burnetii infection: a paradigm change","volume":"30","author":"Eldin","year":"2017"},{"key":"b32","series-title":"Clin Infect Dis","first-page":"116","article-title":"Coxiella burnetii infection of aneurysms or vascular grafts: report of seven cases and review","volume":"26","author":"Fournier","year":"1998"},{"key":"b33","series-title":"Mayo Clin Proc","first-page":"253","article-title":"Q fever endocarditis in the United States","volume":"79","author":"Gami","year":"2004"},{"key":"b34","series-title":"J Clin Microbiol","first-page":"4919","article-title":"Molecular detection of Coxiella burnetii in the sera of patients with Q fever endocarditis or vascular infection","volume":"42","author":"Fenollar","year":"2004"},{"key":"b35","series-title":"J Infect","first-page":"S2","article-title":"Recent advances in the study of Q fever epidemiology, diagnosis and management","volume":"71","author":"Million","year":"2015"},{"key":"b36","series-title":"Clin Infect Dis","first-page":"57","article-title":"Immunoglobulin G anticardiolipin antibodies and progression to Q fever endocarditis","volume":"57","author":"Million","year":"2013"},{"key":"b37","series-title":"Medicine (Baltimore)","first-page":"e4287","article-title":"18F-FDG PET\/CT as a central tool in the shift from chronic Q fever to Coxiella burnetii persistent focalized infection: a consecutive case series","volume":"95","author":"Eldin","year":"2016"},{"key":"b38","series-title":"J Clin Microbiol","first-page":"1823","article-title":"Diagnosis of Q fever","volume":"36","author":"Fournier","year":"1998"}],"container-title":["The American Journal of Tropical Medicine and 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