A Rare Q-Fever Infection Diagnosed Using Metagenomic Next-Generation Sequencing in Liver Transplantation Patient: A Case Report and Literature Review

Q fever is a zoonotic disease caused by the Gram-negative bacterium Coxiella burnetii, typically transmitted through exposure to infected animal secretions. As the clinical signs of Q-fever are largely non-specific in humans, a definitive diagnosis can often be overlooked, particularly when physicians fail to consider C. burnetii on the list of differentials. This case report describes Q-fever in a male patient who had previously undergone orthotopic liver transplantation. The patient had a sudden onset of fever and received the anti-infective moxifloxacin which proved ineffective. Despite the comprehensive laboratory tests and CT imaging that were performed, the etiology remained undetermined. The patient's blood was subjected to metagenomic next-generation sequencing (mNGS), which identified C. burnetii, after which the patient was treated with doxycycline and recovered well. Eight literature articles on Q fever infection in solid organ transplant recipients were reviewed. To our knowledge, this is the first case of Q fever identified by mNGS in an organ transplantation patient. The case underscores the potential of mNGS has in aiding the rapid detection of rare pathogens in immunocompromised patients.