Clinical characteristics of patients with Q fever and lymphoma reported in this study
| Patient . | Type of C burnetii infection (score)* . | First lymphadenopathy or mass/anatomical proximity with Q fever . | Delay between Q fever and lymphoma, mo/chronology consistent with temporal criterion‡ . | Histology/Ann Arbor stage . | C burnetii detection in the lymphoma biopsy specimen . | |
|---|---|---|---|---|---|---|
| Age, y (Q fever)/Sex . | Country (region) . | Serology† . | ||||
| Patient 1 76/M | France (Provence-Alpes-Côte-d’Azur) | Definite vascular infection (25)§ (A1B2C2) 800, 0, 400/1600, 0, 800 | Latero-aortic§/Yes (see supplemental Figure 1) | 20 mo/Yes | Low-grade follicular BCL/III | Yes |
| Patient 2 65/M | France (Alsace) | Definite endocarditis (A0B2C3)|| 3200, 200, 200/6400, 400, 400 | Left pectoral mass/Yes | 21 mo/Yes | DLBCL/III | Yes |
| Patient 3 44/F | France (Aquitaine) | Acute Q fever (abdominal lymphadenitis) 50, 25, 0/100, 50, 0 | Splenic/Unknown | 0.5 mo/Yes | DLBCL/IV | Yes |
| Patient 4 70/M | France (Provence-Alpes-Côte-d’Azur) | Definite endocarditis on prosthetic mitral valve (A0B1C3) 1600, 0, 0/3200, 0, 0 | Mediastinal/Yes | 1 mo/Yes | DLBCL/IV | Yes |
| Patient 5 52/M | France (Pays de la Loire) | Chronic Q fever lymphadenitis 800, 0, 0/1600, 0, 0 | Cervical/Yes | 0.5 mo/Yes | DLBCL/IV | No |
| Patient 6 58/M | France (Rhône-Alpes) | Definite endocarditis of prosthetic aortic valve (A0B1C3)¶ 800, 0, 400/1600, 0, 800 | Mediastinal mass contiguous to left atrial appendage/Yes | −4 mo/Yes# | DLBCL/IV | No |
| Patient 7 72/F | France (Provence-Alpes-Côte-d’Azur) | Acute Q fever (100 400,0/200 800,0) with valvulopathy progressing to possible endocarditis of native mitral valve (A0B0C3) 1600, 50, 50/3200, 100, 100 | Mediastinal and right lung tumor/Yes | 4 mo after acute Q fever and 1 mo after endocarditis diagnosis/Yes | DLBCL/IV | No |
| Patient . | Type of C burnetii infection (score)* . | First lymphadenopathy or mass/anatomical proximity with Q fever . | Delay between Q fever and lymphoma, mo/chronology consistent with temporal criterion‡ . | Histology/Ann Arbor stage . | C burnetii detection in the lymphoma biopsy specimen . | |
|---|---|---|---|---|---|---|
| Age, y (Q fever)/Sex . | Country (region) . | Serology† . | ||||
| Patient 1 76/M | France (Provence-Alpes-Côte-d’Azur) | Definite vascular infection (25)§ (A1B2C2) 800, 0, 400/1600, 0, 800 | Latero-aortic§/Yes (see supplemental Figure 1) | 20 mo/Yes | Low-grade follicular BCL/III | Yes |
| Patient 2 65/M | France (Alsace) | Definite endocarditis (A0B2C3)|| 3200, 200, 200/6400, 400, 400 | Left pectoral mass/Yes | 21 mo/Yes | DLBCL/III | Yes |
| Patient 3 44/F | France (Aquitaine) | Acute Q fever (abdominal lymphadenitis) 50, 25, 0/100, 50, 0 | Splenic/Unknown | 0.5 mo/Yes | DLBCL/IV | Yes |
| Patient 4 70/M | France (Provence-Alpes-Côte-d’Azur) | Definite endocarditis on prosthetic mitral valve (A0B1C3) 1600, 0, 0/3200, 0, 0 | Mediastinal/Yes | 1 mo/Yes | DLBCL/IV | Yes |
| Patient 5 52/M | France (Pays de la Loire) | Chronic Q fever lymphadenitis 800, 0, 0/1600, 0, 0 | Cervical/Yes | 0.5 mo/Yes | DLBCL/IV | No |
| Patient 6 58/M | France (Rhône-Alpes) | Definite endocarditis of prosthetic aortic valve (A0B1C3)¶ 800, 0, 400/1600, 0, 800 | Mediastinal mass contiguous to left atrial appendage/Yes | −4 mo/Yes# | DLBCL/IV | No |
| Patient 7 72/F | France (Provence-Alpes-Côte-d’Azur) | Acute Q fever (100 400,0/200 800,0) with valvulopathy progressing to possible endocarditis of native mitral valve (A0B0C3) 1600, 50, 50/3200, 100, 100 | Mediastinal and right lung tumor/Yes | 4 mo after acute Q fever and 1 mo after endocarditis diagnosis/Yes | DLBCL/IV | No |
BCL, B-cell lymphoma; F, female; M, male.
Endocarditis and vascular infection were defined according to recently updated criteria.30
Phase 1: IgG, IgM, IgA; phase 2: IgG, IgM, IgA.
A temporal succession was considered when C burnetii primary infection preceded lymphadenitis and lymphoma.
Index case with positive C burnetii culture and PCR on surgical blood clot.
Positive C burnetii PCR on resected valve.
Positive C burnetii PCR on blood.
As Q fever endocarditis can last for years, a diagnosis of lymphoma 4 mo before Q fever endocarditis diagnosis is consistent with the temporality criteria.