A patient with a vascular graft is at risk for chronic Q fever following exposure. A high index of suspicion is required for diagnosis.
When to consider Q fever in a patient with a vascular graft:
(1) fever of unknown origin (FUO) with systemic symptoms
(2) history of exposure to raw milk, ruminant animals or travel to a region with endemic Q fever
(3) presence of abdominal discomfort and/or hepatitis
(4) laboratory signs of inflammation (elevated ESR, C-reactive protein, etc.)
(5) negative blood cultures
Clinical improvement often occurs after removal of the infected graft. The graft may show nonspecific findings with thrombi, foamy macrophages, calcifications and/or poorly formed granulomas.
Diagnostic tests:
(1) serology for antibodies to Coxiella burnetii
(2) PCR
(3) immunohistochemistry
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