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Low antibodies titer and serological cross-reaction between Coxiella burnetii and Legionella pneumophila challenge the diagnosis of mediastinitis, an emerging Q fever clinical entity

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Abstract

Background

Coxiella burnetii is an intracellular and fastidious bacterium responsible of acute and persistent Q fever infection. Endocarditis and vascular infections are the most common serious complications of acute Q fever.

Case report

We report the case of a 63-year-old man that presented a mediastinitis associated with a prosthetic vascular infection. Serological cross-reaction was observed between Coxiella burnetii, the agent of Q fever, and Legionella pneumophila with higher antibodies titer for L. pneumophila (IgG = 1:512) than for C. burnetii (phase I IgG = 1:400). We performed western blot with cross-adsorption that supports the diagnosis of C. burnetii infection. Two weeks later, a positive qPCR and culture for C. burnetii on swab taken from the mediastinal cutaneous fistula confirmed the definitive microbiological diagnosis of Q fever mediastinitis.

Conclusion

Cross-reactivity between C. burnetii and Legionella spp. has long been known and should be considered in patients with persistent infections. It is important to establish the definite diagnosis because the antibiotic treatment regimens and duration are significantly different. To the best of our knowledge, we reported here the first case of mediastinitis associated to C. burnetii and we diagnosed this persistent infection despite low anti-C. burnetii phase I IgG levels.

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Authors and Affiliations

  1. Aix Marseille Univ, CNRS, IRD, INSERM, AP-HM, URMITE, IHU Méditerranée-Infection, 19-21 Boulevard Jean Moulin, 13005, Marseille, France

    Sophie Edouard, Matthieu Million, Jean-Paul Casalta, Bernard Amphoux & Didier Raoult

  2. Department of Cardiac Surgery, Centre Hospitalier Universitaire, Hôpital de La Timone, AP-HM, Aix-Marseille University, Marseille, France

    Frédéric Collart

Authors
  1. Sophie Edouard
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  2. Matthieu Million
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  3. Jean-Paul Casalta
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  4. Frédéric Collart
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  5. Bernard Amphoux
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  6. Didier Raoult
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Corresponding author

Correspondence to Didier Raoult.

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Ethical standards

The study was approved by our IHU ethics committee (number 2016-024).

Conflict of interest

The authors declare that they have no conflict of interest.

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Edouard, S., Million, M., Casalta, JP. et al. Low antibodies titer and serological cross-reaction between Coxiella burnetii and Legionella pneumophila challenge the diagnosis of mediastinitis, an emerging Q fever clinical entity. Infection 45, 911–915 (2017). https://doi.org/10.1007/s15010-017-1048-6

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  • DOI: https://doi.org/10.1007/s15010-017-1048-6

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