Case report: Alison Hunter

By Christine Hunter

For the past decade patients diagnosed with chronic fatigue syndrome have been shamefully mistreated due to government policy failure and lack of medical education.

Case Report by Sukocheva et al.BMC Infectious Diseases (2016) 16:165, Coxiella burnetii dormancy in a fatal ten year multisystem dysfunctional illness: case report.

Routine autopsy findings in 1996 were limited. Assurance was given that formalin fixed paraffin embedded tissue blocks could be retained for 30 plus years for examination when ME/CFS biomedical research had progressed. Frozen tissues also retained were lost in freezer breakdown in 2000.  

At the 2005 ME/CFS meeting in Adelaide, paediatrician Dr Katherine Rowe reported that she always tested for Q fever if young people with CFS have had contact with farms. In 2009/10 it was requested due to frequent farm visits that the autopsy tissue blocks should be tested for Q fever.

Detailed neuropathology studies commenced in 2009.

The report said the aim was “to identify possible factors driving severe disturbance of homeostasis  and organ dysfunction exhibited by the courses of the patient’s illness” and said “the negative organ and tissue profile was in sharp contrast to the severity of the symptomatic effects during life that included abnormal disabling fatigue, transient loss of consciousness (“blackouts”), loss of control over electrolyte balance and unexplained tissue oedema”.

Further post-mortem study found Coxiella burnetii (also known as Q fever) cell components in various organs and astrocytes of the brain.

“During the patient’s life, extensive clinical and laboratory  investigations from different disciplinary standpoints failed to deliver definitive identification of a cause.”

The diagnosis of chronic fatigue syndrome was confirmed by numerous specialists.

The post-mortem report  explained that “the most compelling and coherent explanation is one of a severe attack of primary Q fever and a subsequent multisystem organ dysfunction …ending in 1996 with cardiac and cerebral dysfunction i.e., a complex, severe idiopathic illness labelled descriptively at the time as post (viral)infection fatigue syndrome”.

The case report also states “the terms post infection fatigue syndrome or Q fever fatigue syndrome while correctly labelling a major clinical presentation do not do justice to the range of different effects or multiple host organ systems involved, particularly as illustrated in an unusual and exceptionally severe case such a patient BI”.  

Professor Barrie Marmion AO DSc FRCPA FRACP FRS-E founded the Adelaide Q-fever Research Group in 1980 and developed the highly effective Q-fever vaccine prophylaxis programs with CSL Ltd and State Health Departments. During 1953-56 together with Sir Michael Stoker FRS Cambridge they had identified subacute Q-fever endocarditis as the first recognised long-term sequel to acute Q-fever. Professor Marmion later identified the post Q-fever (infection) fatigue syndrome (QFS) as a second significant chronic complication, with the influence of immunogenetic variation on the development of QFS and Q-fever endocarditis and associated cytokine dysregulation.

Further reading:

Related articles: Review: Search PubMed for Marmion BP Q fever Items 1-43

2005 ME/CFS Research Forum University of Adelaide ‘Oral presentation Acute and Chronic Fatigue Q Fever and its post infection fatigue syndrome’ by Emeritus Professor Barrie Marmion AO DSc MD FRACP FRAC Path.