Chronic sternal wound infection and endocarditis with Coxiella burnetii

Chronic Q fever is most commonly associated with culture-negative endocardi tis and less frequently with infection of vascular grafts, infection of ane urysms, hepatitis, pulmonary disease, osteomyelitis, and neurological abnor malities. We report a case of chronic sternal wound infection, polyclonal g ammopathy, and mixed cryoglobulinemia in which Q fever endocarditis was sub sequently diagnosed. Polymerase chain reaction analysis of the wound tissue was positive for Coxiella burnetii DNA, and treatment of the endocarditis resulted in prompt healing of the wound. Chronic Q fever can occur without epidemiological risk factors for C. burnetii exposure and can produce multi system inflammatory dysfunction, aberrations of the immune system, and pers istent wound infections.