A case of chronic Q fever is described, presenting as a problem of endocarditis of six years' duration with negative blood cultures. The Q-fever endocarditis was superimposed on pre-existing rheumatic mitral valve disease. In spite of four months' treatment with tetracycline the patient died of intractable cardiac failure. At necropsy, inclusion bodies were found in macrophages in the mitral valve, and an organism, probably a strain of Rickettsia burneti, was isolated from post-mortem material. A review of eight previously reported cases of chronic Q-fever endocarditis from this country has shown that in the majority of patients the diagnosis was made months or years after the onset of infection by this organism. With the exception of a case diagnosed after 10 months of illness and treated with tetracycline for eight weeks, these patients received either no specific treatment or a short course of tetracycline or chloramphenicol. It is suggested that the failure of antibiotic therapy in this and other reported cases may be, in part at least, due to a delay in diagnosis and in initiation of prolonged specific therapy.
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