Journal of IiME Volume 1 Issue 2 Chronic Fatigue Syndrome after Q fever (continued) www.investinme.org negative. Transthoracic and transesophageal heart ultrasound showed no signs of endocarditis. Ultrasound of abdomen was also normal. Rheumatoid factor, antinuclear antibodies, and antimitochondrial antibodies were negative. Biphasic ELISA test for Coxiella burnetii showed positive IgA antibodies in phase I (Table 2). After completing three months of antibiotic treatment with doxycycline, the patient still had fatigue, disrupted sleep, headaches, and muscle and joint pain. He still fulfills the criteria for CSF, cannot go back to work, and awaits realization of his retirement (Table 1). DISCUSSION Three patients with diagnoses of chronic fatigue syndrome after Q fever are described. Positive IgA antibodies for phase I of the Coxiella burnetii growth cycle suggest the possibility of chronic infection and the presence of Coxiella burnetii in macrophages [7]. Two of the patients described in this study had positive IgA antibodies for phase I of the Coxiella burnetii growth cycle and serology which was consistent with chronic Coxiella burnetii infection, while patient No. 1 had negative serology for chronic Coxiella burnetii infection (Table 2). As there are no clinical signs or laboratory tests that could Invest in ME Charity Nr 1114035 be taken as definite proof of CFS, the disease is diagnosed based on the patients’ symptoms and by excluding other diseases with similar symptoms [8]. In the last ten years, Q fever has been included in a group of diseases that are associated with the development of CFS after the acute phase of illness [7]. A recent article by Hickie et al. suggests that postinfective fatigue syndrome can occur after clinical infection by several different viral and non-viral microorganisms. The authors suggest that the CFS phenotype was stereotyped and occurred with similar incidence after Epstein-Barr virus, Q fever, and Ross River virus infection. The occurrence of CFS was predicted in the highest degree by the severity of the acute infection [12]. All our patients had moderately severe acute illness. Helbig and associates suggest a genetic predisposition for CFS[13]. Analyzing patients who had Q fever in England, Ayres and associates established that long persistence of fatigue, increased sweating, blurred vision, and shortening of breath are manifested more commonly in the group of patients that suffered from Q fever than in the control group [14]. Similar results were obtained by (continued on page 33) Page 32/72

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