Has Coxiella burnetii (Q fever) Been Introduced into New Zealand?

grade fever of 2 months' duration. His past medical history was unremark-able, except for pulmonary tuberculosis treated 55 years earlier and chronic glaucoma. He lived in a rural area and had rare contact with cattle. On admission , his body temperature was 39.5°C; his right laterocervical lymph nodes were enlarged (3 cm x 4 cm) and inflamed. Blood values were unre-markable except for an elevated C-reactive protein level of 150 mg/L (normal<6). A computed tomography scan of the chest showed hilar calcifi-cations and enlarged mediastinal lymph nodes. A biopsy of cervical lymph nodes indicated granulomatous lymphadenitis with foci of necrosis. C. burnetii DNA was detected on the lymph nodes with a C. burnetii–spe-cific pair of primers that amplified an htpAB-associated repetitive element (6). Results of serologic testing by indirect immunofluorescence (IF) were positive for C. burnetii with immunoglobulin (Ig) G antibody titer to phase 1 and phase 2 antigen of 800 and 1,600, respectively, and IgM anti-body titer to phase 2 antigen of 50. A 44-year-old man was admitted to the hospital because of a continuous low-grade fever of 3 months' duration. He had worked as a farmer for 15 years and assisted in the birth of sheep and cattle. On admission, his body temperature was 38°C, and right inguinal lymph nodes were inflamed, measuring 4 x 4 cm. A lymph node biopsy showed granulomatous lym-phadenitis with stellate abscesses surrounded by palisading epithelioid cells. Serologic testing by indirect IF was positive for C. burnetii with an IgG antibody titer to phase 1 antigen of 320. For both patients, results of Ziehl staining and Lowenstein (Bio-Rad, Marne-La-Coquette, France) cultures of gastric aspirates (x 3) and lymph node specimens were negative for mycobaceria, as were the results of tuberculin skin tests. Other diseases were ruled out, including brucellosis, yersiniosis, bartonellosis, and chlamy-dial infections (by serologic testing) and fungal infections (parasitologic studies on lymph node tissue). Antinu-clear antibodies were absent, and angiotensin-converting-enzyme values were normal. Both patients received doxycycline, 200 mg once a day, and rifampin, 600 mg twice a day, for 1 year, and the symptoms resolved (follow-up at 18 months for patient 1 and 9 months for patient 2, respectively). For patient 1, serologic testing after 1 year of treatment showed an IgG antibody titer to phase 1 antigen of 320. Granulomatous lymphadenitis has been described during mycobacterial infections, tularemia, cat scratch disease , yersiniosis, lymphogranuloma venereum, histoplasmosis, coccidio-idomycosis, and chronic …