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Autoimmunity and B-cell dyscrasia in acute and chronic Q fever: A review of the literature

  • Anne F.M. Jansen
    Correspondence
    Corresponding author at: Department of Internal Medicine, Division of Infectious Diseases, 463, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
    Affiliations
    Department of Internal Medicine, Division of Infectious Diseases, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands

    Radboud Expert Center for Q fever, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
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  • Ruud P.H. Raijmakers
    Affiliations
    Department of Internal Medicine, Division of Infectious Diseases, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands

    Radboud Expert Center for Q fever, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
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  • Stephan P. Keijmel
    Affiliations
    Department of Internal Medicine, Division of Infectious Diseases, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands

    Radboud Expert Center for Q fever, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
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  • Renate G. van der Molen
    Affiliations
    Department of Laboratory Medicine, Laboratory of Medical Immunology, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
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  • Gerald M. Vervoort
    Affiliations
    Department of Internal Medicine, Division of Infectious Diseases, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
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  • Jos W.M. van der Meer
    Affiliations
    Department of Internal Medicine, Division of Infectious Diseases, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
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  • Marcel van Deuren
    Affiliations
    Department of Internal Medicine, Division of Infectious Diseases, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands

    Radboud Expert Center for Q fever, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
    Search for articles by this author
  • Author Footnotes
    1 Co-author.
    Chantal P. Bleeker-Rovers
    Footnotes
    1 Co-author.
    Affiliations
    Department of Internal Medicine, Division of Infectious Diseases, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands

    Radboud Expert Center for Q fever, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
    Search for articles by this author
  • Author Footnotes
    1 Co-author.

      Highlights

      • Q fever may be accompanied by immunological epiphenomena.
      • Autoantibodies are prevalent in about half of acute and chronic Q fever infections.
      • The most reported autoimmune disease with Q fever is antiphospholipid syndrome.
      • Cryoglobulinaemia has been described in chronic Q fever patients.
      • Immunological epiphenomena may obscure the infectious etiology of the disease.

      Abstract

      Q fever infection can lead to chronic Q fever, a potentially lethal disease occurring in 1–5% of patients infected with Coxiella burnetii, characterized by the persistence of this intracellular bacterium. It usually presents as endocarditis, infected vascular aneurysms, or infected vascular prostheses. This systematic review of the literature discusses the various autoimmune syndromes and B-cell dyscrasias in acute and chronic Q fever patients, that may interfere with or impede recognition and diagnosis of Q fever. Reportedly, high concentrations of anti-cardiolipin antibodies may be found in acute Q fever patients, while specifically cardiac muscle antibodies have been reported during chronic Q fever. Systemic lupus erythematosus and antiphospholipid syndrome are the most frequently reported autoimmune syndromes, followed by neuromuscular disorders and vasculitis. B-cell dyscrasia, mostly cryoglobulinaemia, is predominantly described in chronic Q fever patients with endocarditis. We conclude that immunological (epi)phenomena are not rare during Q fever and may obscure the infectious etiology of the disease.

      Keywords

      Abbreviations:

      aCL (anti-cardiolipin antibodies), ASMA (anti-smooth muscle antibodie), CMA (cardiac muscle antibodies), ANCA (anti-neutrophil cytoplasmic antibodies), ANA (anti-nuclear antibodies), anti-GBM (anti-glomerular basement membrane antibodies), GPLU (IgG Phospholipid Units), PCA (parietal cell antibodies), MGUS (monoclonal gammopathy of unknown significance)
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