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Alqallaf A, Alhashim A, Alajmi M, Alsaqobi A, Al-Adsani W. Coxiella burnetii Endocarditis in a Patient with Systemic Lupus Erythematosus: A Case Report of a Diagnostic Challenge. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e926699. [PMID: 33318463 PMCID: PMC7749446 DOI: 10.12659/ajcr.926699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Male, 43-year-old Final Diagnosis: Q-fever endocarditis Symptoms: Lower limb edema • shortness of breath Medication: — Clinical Procedure: — Specialty: General and Internal Medicine
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Affiliation(s)
- Ahmed Alqallaf
- Division of Nephrology, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | | | - Mohammad Alajmi
- Department of Internal Medicine, Jaber Al-Ahmed Armed Forces Hospital, Kuwait City, Kuwait
| | - Ameerah Alsaqobi
- Department of Internal Medicine, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | - Wasl Al-Adsani
- Department of Internal Medicine, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
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2
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Melenotte C, Million M, Raoult D. New insights in Coxiella burnetii infection: diagnosis and therapeutic update. Expert Rev Anti Infect Ther 2019; 18:75-86. [PMID: 31782315 DOI: 10.1080/14787210.2020.1699055] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Introduction: Coxiella burnetii infection is still challenging physicians, mainly because no international coordination has been stated to standardize the therapeutic strategy and improve the clinical outcomes.Areas covered: Based on the recent knowledge on Q fever, we review here the clinical practices from Q fever diagnosis to therapy. We searched PubMed and Google Scholar to perform the qualitative synthesis.Expert opinion: Four major critical points are highlighted in this review. The first point is that Q fever diagnosis has been reviewed in the light of the new diagnosis tools, including molecular biology, transthoracic echocardiography, and 18F-FDG-PET/CT-scan imaging. Q fever diagnosis results from the presence of a microbiological criterion in addition to a lesional criterion. Second, the identification of the anticardiolipin antibodies as a novel biological predictive marker for acute Q fever complications (hemophagocytic syndrome, acute Q fever endocarditis, alithiasic cholecystitis, hepatitis, and meningitis). Third, the observation of a coincidence between Q fever and non-Hodgkin lymphoma that has made persistent C. burnetii infection a risk of non-Hodgkin lymphoma. Finally, we expose here the close follow-up we proposed from the French National Reference Center for patients with Q fever infection to detect relapse and complications.
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Affiliation(s)
- Cléa Melenotte
- Infectious diseases department, Aix-Marseille University, IRD, APHM, MEPHI, Marseille, France.,Infectious diseases department, IHU - Méditerranée Infection, Marseille, France
| | - Matthieu Million
- Infectious diseases department, Aix-Marseille University, IRD, APHM, MEPHI, Marseille, France.,Infectious diseases department, IHU - Méditerranée Infection, Marseille, France
| | - Didier Raoult
- Infectious diseases department, Aix-Marseille University, IRD, APHM, MEPHI, Marseille, France.,Infectious diseases department, IHU - Méditerranée Infection, Marseille, France
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3
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Jansen AFM, Raijmakers RPH, van Deuren M, Vonk MC, Bleeker-Rovers CP. Chronic Q fever associated with systemic sclerosis. Eur J Clin Invest 2019; 49:e13123. [PMID: 31077590 DOI: 10.1111/eci.13123] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/21/2018] [Accepted: 04/26/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND After the Q fever outbreak in the Netherlands between 2007 and 2010, more than 300 patients with chronic Q fever have been identified. Some patients were also diagnosed with systemic sclerosis, a rare immune-mediated disease. We aimed to increase awareness of concomitant chronic Q fever infection and systemic sclerosis and to give insight into the course of systemic sclerosis during persistent Q fever infection. MATERIALS AND METHODS Chronic Q fever patients were identified after the Dutch Q fever outbreak in 2007-2010. Systemic sclerosis was diagnosed by a scleroderma expert and patients fulfilled the 2013 Classification Criteria for Systemic Sclerosis. RESULTS Four cases presented with chronic Q fever, persistent Coxiella burnetii infection, shortly preceded or followed by the diagnosis of limited cutaneous systemic sclerosis. The three male patients of 60 years or older developed a relatively mild systemic sclerosis, which did not require immunosuppressive therapy during adequate treatment of the chronic Q fever infection. The 58-year-old female patient used immunosuppressives for her newly diagnosed systemic sclerosis at the time she likely developed a chronic Q fever infection. CONCLUSIONS In this case series, chronic Q fever preceding systemic sclerosis was associated with a mild course of systemic sclerosis without the necessity of immunosuppressive drugs, while chronic Q fever development due to immunocompromised state was associated with a more deteriorating course of systemic sclerosis.
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Affiliation(s)
- Anne F M Jansen
- Department of Internal Medicine, Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Expert Center for Q fever, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ruud P H Raijmakers
- Department of Internal Medicine, Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Expert Center for Q fever, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcel van Deuren
- Department of Internal Medicine, Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Expert Center for Q fever, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Madelon C Vonk
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Chantal P Bleeker-Rovers
- Department of Internal Medicine, Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Expert Center for Q fever, Radboud University Medical Center, Nijmegen, The Netherlands
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4
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Autoimmune Manifestations of Acute Q Fever Infection. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2018. [DOI: 10.1097/ipc.0000000000000629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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5
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Prospective Cohort Study of Single-Day Doxycycline Therapy for Mediterranean Spotted Fever. Antimicrob Agents Chemother 2018; 62:AAC.00978-18. [PMID: 30150470 DOI: 10.1128/aac.00978-18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 08/17/2018] [Indexed: 11/20/2022] Open
Abstract
The objective of this study is to evaluate the results of single-day doxycycline therapy for Mediterranean spotted fever (MSF). This is a prospective cohort study of cases with confirmed MSF treated with the single-day doxycycline regimen in a teaching hospital from 1990 to 2015. Patients received two oral doses of 200 mg of doxycycline for 1 day. The outcomes evaluated were the time interval between the start of treatment and apyrexia, the time interval between the start of treatment and disappearance of other symptoms, and the adverse reactions to treatment and death. The study included 158 subjects, 18 of whom (11.4%) had a severe form of MSF and 31 (19.6%) were >65 years. The interval between onset of symptoms and start of treatment was 4.31 ± 1.54 days. All patients recovered uneventfully. Fever disappeared 2.55 ± 1.14 days after the start of treatment. The remaining symptoms (headache, arthromyalgia) disappeared 3.63 ± 1.35 days after the start of treatment. Only one patient had a delay in reaching apyrexia (8 days). The fever disappeared somewhat later in severe cases (median, 3 days; interquartile range [IQR], 2 to 4 days) than in nonsevere cases (median, 2 days; IQR, 2 to 3 days). Likewise, the remaining symptoms disappeared later in severe cases (median, 5 days; IQR, 4 to 6 days) than in nonsevere cases (median, 3 days; IQR, 3 to 4 days). The outcome was similar in both elderly and nonelderly patients. Eight patients had mild adverse effects possibly related to treatment. The results of the study confirm that single-day doxycycline therapy is an effective and well-tolerated treatment for MSF, including elderly patients and severe cases.
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6
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Jansen AFM, Raijmakers RPH, Keijmel SP, van der Molen RG, Vervoort GM, van der Meer JWM, van Deuren M, Bleeker-Rovers CP. Autoimmunity and B-cell dyscrasia in acute and chronic Q fever: A review of the literature. Eur J Intern Med 2018; 54:6-12. [PMID: 29908707 DOI: 10.1016/j.ejim.2018.06.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/15/2018] [Accepted: 06/06/2018] [Indexed: 01/15/2023]
Abstract
Q fever infection can lead to chronic Q fever, a potentially lethal disease occurring in 1-5% of patients infected with Coxiella burnetii, characterized by the persistence of this intracellular bacterium. It usually presents as endocarditis, infected vascular aneurysms, or infected vascular prostheses. This systematic review of the literature discusses the various autoimmune syndromes and B-cell dyscrasias in acute and chronic Q fever patients, that may interfere with or impede recognition and diagnosis of Q fever. Reportedly, high concentrations of anti-cardiolipin antibodies may be found in acute Q fever patients, while specifically cardiac muscle antibodies have been reported during chronic Q fever. Systemic lupus erythematosus and antiphospholipid syndrome are the most frequently reported autoimmune syndromes, followed by neuromuscular disorders and vasculitis. B-cell dyscrasia, mostly cryoglobulinaemia, is predominantly described in chronic Q fever patients with endocarditis. We conclude that immunological (epi)phenomena are not rare during Q fever and may obscure the infectious etiology of the disease.
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Affiliation(s)
- Anne F M Jansen
- Department of Internal Medicine, Division of Infectious Diseases, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands; Radboud Expert Center for Q fever, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Ruud P H Raijmakers
- Department of Internal Medicine, Division of Infectious Diseases, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands; Radboud Expert Center for Q fever, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Stephan P Keijmel
- Department of Internal Medicine, Division of Infectious Diseases, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands; Radboud Expert Center for Q fever, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Renate G van der Molen
- Department of Laboratory Medicine, Laboratory of Medical Immunology, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Gerald M Vervoort
- Department of Internal Medicine, Division of Infectious Diseases, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Jos W M van der Meer
- Department of Internal Medicine, Division of Infectious Diseases, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Marcel van Deuren
- Department of Internal Medicine, Division of Infectious Diseases, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands; Radboud Expert Center for Q fever, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Chantal P Bleeker-Rovers
- Department of Internal Medicine, Division of Infectious Diseases, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands; Radboud Expert Center for Q fever, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
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7
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Rodríguez Y, Rojas M, Gershwin ME, Anaya JM. Tick-borne diseases and autoimmunity: A comprehensive review. J Autoimmun 2018; 88:21-42. [DOI: 10.1016/j.jaut.2017.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/20/2017] [Accepted: 11/20/2017] [Indexed: 12/12/2022]
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8
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Eldin C, Mélenotte C, Mediannikov O, Ghigo E, Million M, Edouard S, Mege JL, Maurin M, Raoult D. From Q Fever to Coxiella burnetii Infection: a Paradigm Change. Clin Microbiol Rev 2017; 30:115-190. [PMID: 27856520 PMCID: PMC5217791 DOI: 10.1128/cmr.00045-16] [Citation(s) in RCA: 530] [Impact Index Per Article: 75.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Coxiella burnetii is the agent of Q fever, or "query fever," a zoonosis first described in Australia in 1937. Since this first description, knowledge about this pathogen and its associated infections has increased dramatically. We review here all the progress made over the last 20 years on this topic. C. burnetii is classically a strict intracellular, Gram-negative bacterium. However, a major step in the characterization of this pathogen was achieved by the establishment of its axenic culture. C. burnetii infects a wide range of animals, from arthropods to humans. The genetic determinants of virulence are now better known, thanks to the achievement of determining the genome sequences of several strains of this species and comparative genomic analyses. Q fever can be found worldwide, but the epidemiological features of this disease vary according to the geographic area considered, including situations where it is endemic or hyperendemic, and the occurrence of large epidemic outbreaks. In recent years, a major breakthrough in the understanding of the natural history of human infection with C. burnetii was the breaking of the old dichotomy between "acute" and "chronic" Q fever. The clinical presentation of C. burnetii infection depends on both the virulence of the infecting C. burnetii strain and specific risks factors in the infected patient. Moreover, no persistent infection can exist without a focus of infection. This paradigm change should allow better diagnosis and management of primary infection and long-term complications in patients with C. burnetii infection.
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Affiliation(s)
- Carole Eldin
- URMITE, UMR CNRS 7278, IRD 198, INSERM U1095, Faculté de Médecine, Marseille, France
| | - Cléa Mélenotte
- URMITE, UMR CNRS 7278, IRD 198, INSERM U1095, Faculté de Médecine, Marseille, France
| | - Oleg Mediannikov
- URMITE, UMR CNRS 7278, IRD 198, INSERM U1095, Faculté de Médecine, Marseille, France
| | - Eric Ghigo
- URMITE, UMR CNRS 7278, IRD 198, INSERM U1095, Faculté de Médecine, Marseille, France
| | - Matthieu Million
- URMITE, UMR CNRS 7278, IRD 198, INSERM U1095, Faculté de Médecine, Marseille, France
| | - Sophie Edouard
- URMITE, UMR CNRS 7278, IRD 198, INSERM U1095, Faculté de Médecine, Marseille, France
| | - Jean-Louis Mege
- URMITE, UMR CNRS 7278, IRD 198, INSERM U1095, Faculté de Médecine, Marseille, France
| | - Max Maurin
- Institut de Biologie et de Pathologie, CHU de Grenoble, Grenoble, France
| | - Didier Raoult
- URMITE, UMR CNRS 7278, IRD 198, INSERM U1095, Faculté de Médecine, Marseille, France
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9
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Ferraz RV, Andrade M, Silva F, Andrade P, Carvalho C, Torres JP, Almeida J, Sarmento A, Santos L. Chronic Q fever: A missed prosthetic valve endocarditis possibly for years. IDCases 2016; 6:55-57. [PMID: 27713859 PMCID: PMC5048103 DOI: 10.1016/j.idcr.2016.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 11/28/2022] Open
Abstract
Chronic Coxiella burnetii endocarditis usually develops in people with underlying heart disease and accounts for 60–70% of chronic Q fever. Onset is generally insidious and manifestations are atypical. The authors report a case of Coxiella burnetii prosthetic valve endocarditis in a 53 years- old patient with recurrent mechanical valve dehiscence on mitral position. He lived in a rural area with sheep and goats on the surroundings. During a 9 year- period, he was submitted to three cardiac mitral valve surgeries two of which with no Q fever diagnosis suspicion. Diagnosis was based on a positive serology test (Indirect imunofluorescence). Treatment consisted in a combination of prolonged course of hydroxychloroquine plus doxycycline and surgical replacement of the mitral valve, with a favorable outcome. With this case report, the authors pretend to highlight the not always expected diagnosis of Q fever endocarditis. If not considered, Coxiella burnetii endocarditis may lead to multiple cardiac surgeries, greater morbidity and potentially death.
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Affiliation(s)
- Rita Veiga Ferraz
- Infectious Diseases Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, Instituto de Inovação e Investigação em Saúde (I3S), Grupo de I&D em Nefrologia e Doenças Infeciosas, Instituto Nacional de Engenharia Biomédica (INEB), Porto, Portugal
| | - Marta Andrade
- Cardiothoracic Surgery Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, Portugal
| | - Filipa Silva
- Internal Medicine Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, Porto, Portugal
| | - Paulo Andrade
- Infectious Diseases Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, Instituto de Inovação e Investigação em Saúde (I3S), Grupo de I&D em Nefrologia e Doenças Infeciosas, Instituto Nacional de Engenharia Biomédica (INEB), Porto, Portugal
| | - Cláudia Carvalho
- Infectious Diseases Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, Instituto de Inovação e Investigação em Saúde (I3S), Grupo de I&D em Nefrologia e Doenças Infeciosas, Instituto Nacional de Engenharia Biomédica (INEB), Porto, Portugal
| | - José Pinheiro Torres
- Cardiothoracic Surgery Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, Portugal
| | - Jorge Almeida
- Cardiothoracic Surgery Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, Portugal
| | - António Sarmento
- Infectious Diseases Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, Instituto de Inovação e Investigação em Saúde (I3S), Grupo de I&D em Nefrologia e Doenças Infeciosas, Instituto Nacional de Engenharia Biomédica (INEB), Porto, Portugal
| | - Lurdes Santos
- Infectious Diseases Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, Instituto de Inovação e Investigação em Saúde (I3S), Grupo de I&D em Nefrologia e Doenças Infeciosas, Instituto Nacional de Engenharia Biomédica (INEB), Porto, Portugal
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10
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Malov VA, Ponomarev SV, Тarasevich IV, Kubensky EN, Gorobchenko AN, Pantyukhina AN, Nemilostiva EA, Bogdanova MV, Makhmutov YI. [Description of a case of severe Q fever]. TERAPEVT ARKH 2016; 87:84-91. [PMID: 26821422 DOI: 10.17116/terarkh2015871184-91] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The paper considers a rare clinical case of severe Q fever in a young man with no compromised premorbid background. It describes and analyzes clinical manifestations and laboratory findings with consideration for the current data available in the literature. The issues of the differential diagnosis, laboratory diagnosis, and treatment of Q fever are discussed.
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Affiliation(s)
- V A Malov
- Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia
| | - S V Ponomarev
- Acad. N.N. Burdenko Main Military Clinical Hospital, Ministry of Defense of the Russian Federation, Moscow, Russia
| | - I V Тarasevich
- N.F Gamaleya Federal Research Center for Epidemiology and Microbiology, Ministry of Health of Russia, Moscow, Russia
| | - E N Kubensky
- Acad. N.N. Burdenko Main Military Clinical Hospital, Ministry of Defense of the Russian Federation, Moscow, Russia
| | - A N Gorobchenko
- Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia
| | - A N Pantyukhina
- N.F Gamaleya Federal Research Center for Epidemiology and Microbiology, Ministry of Health of Russia, Moscow, Russia
| | - E A Nemilostiva
- Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia
| | - M V Bogdanova
- Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia
| | - Ya I Makhmutov
- Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia
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11
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B-cell non-Hodgkin lymphoma linked to Coxiella burnetii. Blood 2016; 127:113-21. [DOI: 10.1182/blood-2015-04-639617] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 09/06/2015] [Indexed: 02/05/2023] Open
Abstract
Key PointsCoxiella burnetii is associated with an increased risk of lymphoma; its presence in the tumor microenvironment may favor lymphomagenesis. Lymphoma has to be considered in patients with Q fever and lymphoid disorders, especially those with persistent focalized infections.
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12
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Million M, Thuny F, Bardin N, Angelakis E, Edouard S, Bessis S, Guimard T, Weitten T, Martin-Barbaz F, Texereau M, Ayouz K, Protopopescu C, Carrieri P, Habib G, Raoult D. Antiphospholipid Antibody Syndrome With Valvular Vegetations in Acute Q Fever. Clin Infect Dis 2015; 62:537-44. [PMID: 26585519 DOI: 10.1093/cid/civ956] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 11/06/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Coxiella burnetii endocarditis is considered to be a late complication of Q fever in patients with preexisting valvular heart disease (VHD). We observed a large transient aortic vegetation in a patient with acute Q fever and high levels of IgG anticardiolipin antibodies (IgG aCL). Therefore, we sought to determine how commonly acute Q fever could cause valvular vegetations associated with antiphospholipid antibody syndrome, which would be a new clinical entity. METHODS We performed a consecutive case series between January 2007 and April 2014 at the French National Referral Center for Q fever. Age, sex, history of VHD, immunosuppression, and IgG aCL assessed by enzyme-linked immunosorbent assay were tested as potential predictors. RESULTS Of the 759 patients with acute Q fever and available echocardiographic results, 9 (1.2%) were considered to have acute Q fever endocarditis, none of whom had a previously known VHD. After multiple adjustment, very high IgG aCL levels (>100 immunoglobulin G-type phospholipid units; relative risk [RR], 24.9 [95% confidence interval {CI}, 4.5-140.2]; P = .002) and immunosuppression (RR, 10.1 [95% CI, 3.0-32.4]; P = .002) were independently associated with acute Q fever endocarditis. CONCLUSIONS Antiphospholipid antibody syndrome with valvular vegetations in acute Q fever is a new clinical entity. This would suggest the value of systematically testing for C. burnetii in antiphospholipid-associated cardiac valve disease, and performing early echocardiography and antiphospholipid dosages in patients with acute Q fever.
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Affiliation(s)
- Matthieu Million
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Institut Hospitalier Universitaire Méditerranée-Infection, UM63, CNRS7278, IRD198, INSERM1095
| | - Franck Thuny
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Institut Hospitalier Universitaire Méditerranée-Infection, UM63, CNRS7278, IRD198, INSERM1095 Unité Nord Insuffisance cardiaque et Valvulopathies, Service de Cardiologie, Centre Hospitalier Universitaire de Marseille, Hôpital Nord
| | - Nathalie Bardin
- Laboratoire d'Immunologie, Aix-Marseille Université, Marseille
| | - Emmanouil Angelakis
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Institut Hospitalier Universitaire Méditerranée-Infection, UM63, CNRS7278, IRD198, INSERM1095
| | - Sophie Edouard
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Institut Hospitalier Universitaire Méditerranée-Infection, UM63, CNRS7278, IRD198, INSERM1095
| | - Simon Bessis
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Institut Hospitalier Universitaire Méditerranée-Infection, UM63, CNRS7278, IRD198, INSERM1095
| | - Thomas Guimard
- Service d'Infectiologie, Centre Hospitalier Départemental-Vendée, La Roche-sur-Yon
| | - Thierry Weitten
- Service de médecine interne, Centre Hospitalier Intercommunal des Alpes du Sud, Gap
| | | | | | - Khelifa Ayouz
- Service de Médecine Interne, Centre Hospitalier de Saumur
| | - Camelia Protopopescu
- INSERM, UMR912 (SESSTIM), IRD, Aix Marseille Université Observatoire régional de la santé Provence-Alpes-Côte d'Azur
| | - Patrizia Carrieri
- INSERM, UMR912 (SESSTIM), IRD, Aix Marseille Université Observatoire régional de la santé Provence-Alpes-Côte d'Azur
| | - Gilbert Habib
- Service de Cardiologie, Hôpital de La Timone, Marseille, France
| | - Didier Raoult
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Institut Hospitalier Universitaire Méditerranée-Infection, UM63, CNRS7278, IRD198, INSERM1095
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13
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Familial Q fever clustering with variable manifestations imitating infectious and autoimmune disease. Clin Microbiol Infect 2015; 21:459-63. [PMID: 25770747 DOI: 10.1016/j.cmi.2015.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 12/24/2014] [Accepted: 01/08/2015] [Indexed: 11/20/2022]
Abstract
Q fever, caused by Coxiella burnetii, can present as an outbreak of acute disease ranging from asymptomatic disease, pneumonia, hepatitis or fever of unknown origin, which can progress to a chronic disease, most frequently endocarditis. The occurrence of Q fever within families is rarely described, and in most cases presents with uniform acute disease manifestations. Here we present a familial cluster of Q fever presenting as highly variable synchronous manifestations in four of five family members, including prolonged fever of unknown origin, asymptomatic carrier state, hepatitis, and chronic endocarditis developing in the absence of previous symptoms. This case series highlights the possibility of Q fever developing in cohabitated individuals with highly variable symptoms masking the common disease etiology. Screening of all exposed individuals, even those not clinically suspected to be infected, may enable to better identify, treat and prevent progression to chronic disease.
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Baziaka F, Karaiskos I, Galani L, Barmpouti E, Konstantinidis S, Kitas G, Giamarellou H. Large vessel vasculitis in a patient with acute Q-fever: A case report. IDCases 2014; 1:56-9. [PMID: 26952153 PMCID: PMC4762790 DOI: 10.1016/j.idcr.2014.07.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 07/16/2014] [Accepted: 07/16/2014] [Indexed: 01/12/2023] Open
Abstract
Q fever is a zoonosis caused by the rickettsial organism Coxiella burnetii. Infection has an acute course, usually with a self-limited febrile illness and the possibility of the evaluation to a chronic course with endocardial involvement. The presence of autoantibodies and various autoimmune disorders have also been associated with C. burnetii infection. We report a case of acute Q fever in which the patient developed large vessel vasculitis. The FDG-PET/CT scan detected inflammation of the thoracic aortic wall, suggesting an unusual immunologic host response to acute Q fever infection.
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Affiliation(s)
- Fotini Baziaka
- 6th Department of Internal Medicine, Hygeia General Hospital, Athens, Greece
| | - Ilias Karaiskos
- 6th Department of Internal Medicine, Hygeia General Hospital, Athens, Greece
| | - Lamprini Galani
- 6th Department of Internal Medicine, Hygeia General Hospital, Athens, Greece
| | | | | | - George Kitas
- Department of Rheumatology, Hygeia General Hospital, Athens, Greece
| | - Helen Giamarellou
- 6th Department of Internal Medicine, Hygeia General Hospital, Athens, Greece
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Lai CH, Chang LL, Lin JN, Chen WF, Wei YF, Chiu CT, Wu JT, Hsu CK, Chen JY, Lee HS, Lin HH, Chen YH. Clinical characteristics of Q fever and etiology of community-acquired pneumonia in a tropical region of southern Taiwan: a prospective observational study. PLoS One 2014; 9:e102808. [PMID: 25033402 PMCID: PMC4102556 DOI: 10.1371/journal.pone.0102808] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 06/24/2014] [Indexed: 12/11/2022] Open
Abstract
Background The clinical characteristics of Q fever are poorly identified in the tropics. Fever with pneumonia or hepatitis are the dominant presentations of acute Q fever, which exhibits geographic variability. In southern Taiwan, which is located in a tropical region, the role of Q fever in community-acquired pneumonia (CAP) has never been investigated. Methodology/Principal Findings During the study period, May 2012 to April 2013, 166 cases of adult CAP and 15 cases of acute Q fever were prospectively investigated. Cultures of clinical specimens, urine antigen tests for Streptococcus pneumoniae and Legionella pneumophila, and paired serologic assessments for Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Q fever (Coxiella burnetii) were used for identifying pathogens associated with CAP. From April 2004 to April 2013 (the pre-study period), 122 cases of acute Q fever were also included retrospectively for analysis. The geographic distribution of Q fever and CAP cases was similar. Q fever cases were identified in warmer seasons and younger ages than CAP. Based on multivariate analysis, male gender, chills, thrombocytopenia, and elevated liver enzymes were independent characteristics associated with Q fever. In patients with Q fever, 95% and 13.5% of cases presented with hepatitis and pneumonia, respectively. Twelve (7.2%) cases of CAP were seropositive for C. burnetii antibodies, but none of them had acute Q fever. Among CAP cases, 22.9% had a CURB-65 score ≧2, and 45.8% had identifiable pathogens. Haemophilus parainfluenzae (14.5%), S. pneumoniae (6.6%), Pseudomonas aeruginosa (4.8%), and Klebsiella pneumoniae (3.0%) were the most common pathogens identified by cultures or urine antigen tests. Moreover, M. pneumoniae, C. pneumoniae, and co-infection with 2 pathogens accounted for 9.0%, 7.8%, and 1.8%, respectively. Conclusions In southern Taiwan, Q fever is an endemic disease with hepatitis as the major presentation and is not a common etiology of CAP.
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Affiliation(s)
- Chung-Hsu Lai
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung City, Taiwan
- Division of Infection Control Laboratory, E-Da Hospital/I-Shou University, Kaohsiung City, Taiwan
| | - Lin-Li Chang
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Faculty of Medicine, Department of Microbiology, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Jiun-Nong Lin
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung City, Taiwan
| | - Wei-Fang Chen
- Division of Infection Control Laboratory, E-Da Hospital/I-Shou University, Kaohsiung City, Taiwan
| | - Yu-Feng Wei
- Division of Pulmonary Medicine, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung County, Taiwan
| | - Chien-Tung Chiu
- Division of Pulmonary Medicine, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung County, Taiwan
| | - Jiun-Ting Wu
- Division of Pulmonary Medicine, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung County, Taiwan
| | - Chi-Kuei Hsu
- Division of Pulmonary Medicine, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung County, Taiwan
| | - Jung-Yueh Chen
- Division of Pulmonary Medicine, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung County, Taiwan
| | - Ho-Sheng Lee
- Division of Pulmonary Medicine, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung County, Taiwan
| | - Hsi-Hsun Lin
- Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung City, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei City, Taiwan
| | - Yen-Hsu Chen
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
- * E-mail:
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High seroprevalence of Mycoplasma pneumoniae IgM in acute Q fever by enzyme-linked immunosorbent assay (ELISA). PLoS One 2013; 8:e77640. [PMID: 24147043 PMCID: PMC3798658 DOI: 10.1371/journal.pone.0077640] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 09/13/2013] [Indexed: 11/23/2022] Open
Abstract
Q fever is serologically cross-reactive with other intracellular microorganisms. However, studies of the serological status of Mycoplasma pneumoniae and Chlamydophila pneumoniae during Q fever are rare. We conducted a retrospective serological study of M. pneumoniae and C. pneumoniae by enzyme-linked immunosorbent assay (ELISA), a method widely used in clinical practice, in 102 cases of acute Q fever, 39 cases of scrub typhus, and 14 cases of murine typhus. The seropositive (57.8%, 7.7%, and 0%, p<0.001) and seroconversion rates (50.6%, 8.8%, and 0%, p<0.001) of M. pneumoniae IgM, but not M. pneumoniae IgG and C. pneumoniae IgG/IgM, in acute Q fever were significantly higher than in scrub typhus and murine typhus. Another ELISA kit also revealed a high seropositivity (49.5%) and seroconversion rate (33.3%) of M. pneumoniae IgM in acute Q fever. The temporal and age distributions of patients with positive M. pneumoniae IgM were not typical of M. pneumoniae pneumonia. Comparing acute Q fever patients who were positive for M. pneumoniae IgM (59 cases) with those who were negative (43 cases), the demographic characteristics and underlying diseases were not different. In addition, the clinical manifestations associated with atypical pneumonia, including headache (71.2% vs. 81.4%, p=0.255), sore throat (8.5% vs. 16.3%, p=0.351), cough (35.6% vs. 23.3%, p=0.199), and chest x-ray suggesting pneumonia (19.3% vs. 9.5%, p=0.258), were unchanged between the two groups. Clinicians should be aware of the high seroprevalence of M. pneumoniae IgM in acute Q fever, particularly with ELISA kits, which can lead to misdiagnosis, overestimations of the prevalence of M. pneumoniae pneumonia, and underestimations of the true prevalence of Q fever pneumonia.
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Million M, Walter G, Bardin N, Camoin L, Giorgi R, Bongrand P, Gouriet F, Casalta JP, Thuny F, Habib G, Raoult D. Immunoglobulin G Anticardiolipin Antibodies and Progression to Q Fever Endocarditis. Clin Infect Dis 2013; 57:57-64. [DOI: 10.1093/cid/cit191] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Palmela C, Badura R, Valadas E. Acute Q fever in Portugal. Epidemiological and clinical features of 32 hospitalized patients. Germs 2012; 2:43-59. [PMID: 24432263 DOI: 10.11599/germs.2012.1013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 05/22/2012] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Q fever is a worldwide zoonosis caused by Coxiella burnetii. The main characteristic of acute Q fever is its clinical polymorphism, usually presenting as a febrile illness with varying degrees of hepatitis and/or pneumonia. Q fever is endemic in Portugal, and it is an obligatory notifiable disease since 1999. However, its epidemiological and clinical characteristics are still incompletely described. METHODS We performed a retrospective study of 32 cases admitted in the Infectious Diseases Department, Santa Maria's University Hospital, from January 2001 to December 2010, in whom acute Q fever was diagnosed by the presence of antibodies to phase II Coxiella burnetii antigens associated with a compatible clinical syndrome. RESULTS Out of the 32 cases recorded, 29 (91%) were male, with a male:female ratio of 9.7:1. Individuals at productive age were mainly affected (88%, n=28, with ages between 25 and 64 years). Clinically, the most common manifestation of acute Q fever was hepatic involvement (84%, n=27), which occurred isolated in 53% (n=17) of the cases. Hepatitis was more severe, presenting with higher values of liver function tests, in patients presenting both pulmonary and hepatic involvement. Additionally, we report one case of myocarditis and another one with neurological involvement. Empiric but appropriate antibiotic therapy was given in 66% (n=21) of the cases. There was a complete recovery in 94% (n=30) of the patients, and one death. We confirmed the sub-notification of this disease in Portugal, with only 47% (n=15) of the cases notified. CONCLUSION In Portugal further studies are needed to confirm our results. From the 32 cases studied, acute Q fever presented more frequently as a febrile disease with hepatic involvement affecting mainly young male individuals. Furthermore, acute Q fever is clearly underdiagnosed and underreported in Portugal, which suggests that an increased awareness of the disease is needed, together with a broader use of serological testing.
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Affiliation(s)
| | - Robert Badura
- MD, Infectious and Parasitic Diseases University Clinic, Faculty of Medicine, Santa Maria's University Hospital, Lisbon, Portugal
| | - Emília Valadas
- PhD, Infectious and Parasitic Diseases University Clinic, Faculty of Medicine, Santa Maria's University Hospital, Lisbon, Portugal
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19
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Coxiella burnetii infection of a bovine jugular vein conduit in a child. Pediatr Cardiol 2012; 33:831-3. [PMID: 22349674 DOI: 10.1007/s00246-012-0215-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Accepted: 12/09/2011] [Indexed: 10/28/2022]
Abstract
We report a case of an 11-year-old girl with Coxiella burnetii infection of a bovine jugular vein conduit which is an extremely rare manifestation of Q fever. The role of surgery in the management of C. burnetii endovascular infection and the use of serology are discussed.
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20
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Abstract
AbstractQ fever is a worldwide zoonosis caused by the intracellular bacterium Coxiella burnetti. Autoimmune phenomena associated with the disease may obscure the clinical picture, and in many reports mislead physicians to an initial diagnosis of an autoimmune disease. We present a case of chronic Q-fever, complicated by myocarditis/pericarditis, where patient’s initial signs, symptoms and laboratory findings (i.e., protracted fever, oligoarthritis, erythema nodosum, positive antineutrophil cytoplasmic antibodies, monoclonal gammopathy) seemed to suggest an autoimmune disease. We also review the literature for autoimmune phenomena associated with Q-fever.
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21
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Immunological arousal during acute Q fever infection. Eur J Clin Microbiol Infect Dis 2011; 30:1527-30. [PMID: 21509477 DOI: 10.1007/s10096-011-1255-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2010] [Accepted: 03/28/2011] [Indexed: 10/18/2022]
Abstract
Physicians often encounter patients who present with a vague clinical syndrome. A wide serological workup is often ordered, which may include tests for Coxiella burnetii in endemic areas. Often, the results of these tests pose new dilemma, with overlapping positive laboratory assays. The objective of this investigation was to characterise the serological overlap between acute Q fever and other infectious and immunological diseases. We retrospectively scanned the files of patients with a positive or equivocal immunoglobulin (Ig) M for C. burnetii phase II over a period of 8 years in a general hospital. Clinical and laboratory data, including antibodies to infectious agents and antibodies related to immunological states, were recorded. Anti-nuclear antibody (ANA), smooth muscle antibody (SMA) and rheumatoid factor were positive in 38%, 33.3% and 22.2% of the cases, respectively. In patients with acute Q fever, elevated IgM levels for Epstein-Barr Virus (EBV), cytomegalovirus (CMV), Mycoplasma pneumoniae, parvovirus, Bordetella pertussis, Rickettsia conorii and R. typhi were noted in 13.8%, 8.3%, 12.12%, 22.2%, 25%, 13% and 21.7% of cases, respectively. Acute Q fever induces a non-specific immunological arousal in a significant number of patients. This may interfere with diagnosis and delay treatment. Caution, clinical judgment and serological follow-up is warranted in such conditions.
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22
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Gikas A, Kokkini S, Tsioutis C. Q fever: clinical manifestations and treatment. Expert Rev Anti Infect Ther 2010; 8:529-39. [PMID: 20455682 DOI: 10.1586/eri.10.29] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Public awareness and advances in the diagnostic approach to Q fever have provided important information on epidemiological and clinical aspects of this zoonosis. Coxiella burnetii infection exhibits various acute or chronic clinical forms, and infection during pregnancy may jeopardize the integrity of the fetus. The presentation of infection is often nonspecific and this hinders prompt diagnosis. Therapeutic regimens vary, and treating Q fever during pregnancy and childhood is often challenging. Increasing clinical experience with C. burnetii infections has helped create treatment protocols and follow-up algorithms that have considerably improved management and prognosis. Vaccines are available, although their use is still limited.
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Affiliation(s)
- Achilleas Gikas
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, Heraklion 71110, Crete, Greece.
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23
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Circulating cytokines and procalcitonin in acute Q fever granulomatous hepatitis with poor response to antibiotic and short-course steroid therapy: a case report. BMC Infect Dis 2010; 10:193. [PMID: 20594295 PMCID: PMC2909238 DOI: 10.1186/1471-2334-10-193] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2010] [Accepted: 07/01/2010] [Indexed: 11/24/2022] Open
Abstract
Background Q fever is a zoonosis distributed worldwide that is caused by Coxiella burnetii infection and the defervescence usually occurs within few days of appropriate antibiotic therapy. Whether the changes of cytokine levels are associated with acute Q fever with persistent fever despite antibiotic therapy had not been investigated before. Case Presentation We report a rare case of acute Q fever granulomatous hepatitis remained pyrexia despite several antibiotic therapy and 6-day course of oral prednisolone. During the 18-month follow-up, the investigation of the serum cytokines profile and procalcitonin (PCT) revealed that initially elevated levels of interleukin-2 (IL-2), IL-8, IL-10, and PCT decreased gradually, but the IL-6 remained in low titer. No evidence of chronic Q fever was identified by examinations of serum antibodies against C. burnetii and echocardiography. Conclusions The changes of cytokine levels may be associated with acute Q fever with poor response to treatment and PCT may be an indicator for monitoring the response to treatment.
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Marrie TJ, Raoult D. Q fever--a review and issues for the next century. Int J Antimicrob Agents 2010; 8:145-61. [PMID: 18611796 DOI: 10.1016/s0924-8579(96)00369-x] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/1996] [Indexed: 11/25/2022]
Affiliation(s)
- T J Marrie
- Department of Medicine, Dalhousie University, Halifax, N.S., Canada
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Diarrea: presentación atípica de la fiebre Q. Enferm Infecc Microbiol Clin 2009; 27:546-7. [DOI: 10.1016/j.eimc.2008.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Revised: 09/24/2008] [Accepted: 09/29/2008] [Indexed: 11/18/2022]
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Ohgimi C, Tanaka R, Oh-ishi T. [A case report of acute Q fever showing Kawasaki disease-like symptoms in a 9-year-old girl]. ACTA ACUST UNITED AC 2009; 83:245-50. [PMID: 19522308 DOI: 10.11150/kansenshogakuzasshi.83.245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A 9-year-old girl developing fever and hyperemia of both bulbar conjunctiva 5 days before admission to the Saitama Children's Medical Center after antibiotics proved ineffective was found on admission to have general fatigue and a temperature of 39 degrees C. Physical examination showed hyperemia of the bulbar conjunctiva, fissures of the lips, redness of the pharynx, and swelling of the cervical lymph nodes. Laboratory tests detected neutrophilia (11,200/microL), mild anemia (11.4g/dL), thrombocytopenia (110,000/microL), and elevated serum aspartate aminotransferase (242IU/L), alanine aminotransferase (328IU/L), and C-rective protein (25.2 mg/dL). Autoantibodies such as anti-nuclear, anti-SS-A/Ro, and anti-Jo-1 were also found. Echocardiography showed no abnormality of the coronary arteries. She was diagnosed as having incomplete Kawasaki disease on day 7 of illness, necessitating that a high dose of immunoglobulin be given intravenously. Her temperature dropped temporarily to 37 degrees C, but she developed erythema of the cheek and fever. Intravenous immunoglobulin was restarted, and minocycline introduced because her daily contact with a pet cat indicated richettsial infection such as Q fever. Mild fever, muscle pain, and elevated C-reactive protein did not improve, but clinical signs and symptoms gradually lessened after ibuprofen was given, then disappeared. A definitive diagnosis of Q fever was made through an over 4-fold rise in phase II IgG antibody titers against Coxiella burnetii, titer of less than 1 : 16 on day 14 of illness, and titer of 1 : 256 on day 34. This case study describes on atypical case of Q fever with clinical manifestations mimicking Kawasaki disease.
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Affiliation(s)
- Chikara Ohgimi
- Division of Infectious Disease, Immunology, and Allergy, Saitama Children's Medical Center
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Coxiella burnetii as a possible cause of autoimmune liver disease: a case report. J Med Case Rep 2009; 3:8870. [PMID: 19830243 PMCID: PMC2737777 DOI: 10.4076/1752-1947-3-8870] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2009] [Accepted: 03/02/2009] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Q fever is a zoonotic infection that may cause severe hepatitis. Q-fever hepatitis has not yet been associated with autoimmune hepatitis and/or primary biliary cirrhosis. CASE PRESENTATION We describe a 39-year-old man of Sri Lankan origin with chronic Q-fever hepatitis who developed autoantibodies compatible with autoimmune hepatitis/primary biliary cirrhosis overlap syndrome. Ursodeoxycholic acid in addition to antibiotic therapy markedly improved hepatic enzyme levels suggesting that autoimmunity, potentially triggered by the underlying infection, was involved in the pathogenesis of liver damage. CONCLUSION We suggest that Coxiella burnetii might trigger autoimmune liver disease. Patients with Q-fever hepatitis who respond poorly to antibiotics should be investigated for serological evidence of autoimmune hepatitis, primary biliary cirrhosis or overlap syndrome, as these patients could benefit from adjunctive therapy with ursodeoxycholic acid. Conversely, C. burnetii serology might be necessary in patients with autoimmune liver disease in order to exclude underlying Coxiella infection.
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Cunha BA, Nausheen S, Busch L. Severe Q fever community-acquired pneumonia (CAP) mimicking Legionnaires' disease: Clinical significance of cold agglutinins, anti-smooth muscle antibodies and thrombocytosis. Heart Lung 2009; 38:354-62. [PMID: 19577708 DOI: 10.1016/j.hrtlng.2008.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Accepted: 07/09/2008] [Indexed: 10/21/2022]
Abstract
Atypical community-acquired pneumonia (CAP) may be caused by zoonotic or nonpulmonary pathogens. However, atypical pathogens are systemic infectious disease accompanied by pneumonia in contrast with typical bacterial pathogens with infection limited to the lungs and absent extrapulmonary findings. Clinically and radiologically, the atypical CAP pathogens that most closely resemble each other are psittacosis, Q fever, and Legionnaires' disease. Psittacosis can usually be readily suspected or eliminated on the basis of a recent psittacine bird contact history. The 2 atypical pneumonias that most closely resemble each other clinically are Q fever and Legionnaires' disease. The epidemiology of Q fever is related to livestock, and sporadic cases are related to contact to parturient cats. In nonendemic areas, Q fever CAP mimics Legionnaires' disease most closely. Both Q fever and Legionella CAP have several clinical and laboratory features in common. However, there are subtle but important differences that allow the astute clinician to differentiate between these 2 disorders on the basis of clinical and nonspecific laboratory findings before definitive diagnostic tests results are reported. We report a case of severe Q fever CAP mimicking Legionnaires' disease in a young adult normal host. Her initial zoonotic contact history was negative, and her clinical presentation suggested Legionnaires' disease as the most likely diagnosis. Against the diagnosis of Legionnaires' disease was the patient's age and occurrence of the disease in spring time. In contrast, Legionnaires' disease is usually an infection of older individuals and occurs in late summer/fall. Although the patient did not have splenomegaly, a common finding in Q fever CAP, she did have mild hepatomegaly. Hepatomegaly is a uncommon in Q fever CAP but is not a feature of Legionnaires' disease. In the absence of a positive zoonotic contact history, the cardinal findings pointing to the diagnosis of Q fever in this case were "multiple round opacities" on chest computed tomography scan and thrombocytosis during her hospitalization. Against the diagnosis of Legionnaires' disease was the absence of hypophosphatemia and highly elevated ferritin levels. In patients with atypical pneumonias in whom the clinical presentation and nonspecific laboratory findings suggest Legionnaires' disease, but in addition have findings not associated with Legionnaires' (eg, hepatomegaly, thrombocytosis), Q fever serology should be ordered. We conclude that Q fever may closely mimic Legionnaires' disease. Severe atypical CAP with "multiple round opacities" on chest x-ray/computed tomography chest scan with elevated anti-smooth muscle antibodies or thrombocytosis should suggest the diagnosis of Q fever and prompt specific testing for Q fever. Rarely, Q fever CAP may be associated with elevated cold agglutinin titers.
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Affiliation(s)
- Burke A Cunha
- Infectious Disease Division, Winthrop-University Hospital, Mineola, New York 11501, USA
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30
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Lai CH, Huang CK, Chin C, Chung HC, Huang WS, Lin CW, Hsu CY, Lin HH. Acute Q fever: an emerging and endemic disease in southern Taiwan. ACTA ACUST UNITED AC 2008; 40:105-10. [PMID: 17852909 DOI: 10.1080/00365540701558722] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Acute Q fever is a worldwide zoonosis caused by Coxiella burnetii infection. In Taiwan, cases of acute Q fever increased during 3 y of observation, especially at Kaohsiung County and City in southern Taiwan. From 15 April 2004 to 15 April 2007, a total of 67 cases of acute Q fever were identified at E-Da hospital located at Kaohsiung County. 19 (28.4%) patients had a history of travel in rural areas and only 1 had been outside southern Taiwan. 21 (31.3%) patients had a history of animal contact. 20 (30.8%) of the 65 examined patients had underlying chronic hepatitis B or hepatitis C virus infection. Fever (98.5%), chills (79.1%), headache (79.1%), relative bradycardia (44.8%), elevated aminotransferases (100%), and thrombocytopenia (74.6%) were common manifestations. 12 (19.0%) cases had abnormal findings on chest X-ray. Fatty liver (50.0%) and hepatomegaly and/or splenomegaly (41.9%) were found by abdominal image examinations. 42 (76.4%) of 55 cases had defervescence within 3 d after treatment, whereas 4 (7.3%) had spontaneous remission. Acute Q fever is an endemic infectious disease with hepatitis rather than pneumonia as the major presentation in southern Taiwan and the emergence of Q fever is due to increased alertness for the disease by physicians.
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Affiliation(s)
- Chung-Hsu Lai
- Sections of Infectious Diseases, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaoshiung County, Taiwan, Republic of China
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31
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Kaabia N, Letaief A. [Q Fever in Tunisia]. ACTA ACUST UNITED AC 2008; 57:439-43. [PMID: 18554822 DOI: 10.1016/j.patbio.2008.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2008] [Accepted: 04/11/2008] [Indexed: 10/22/2022]
Abstract
Q fever is a common zoonosis with almost a worldwide distribution caused by Coxiella burnetii. Farm animals and pets are the main reservoirs of infection and transmission to humans is usually via inhalation of contaminated aerosols. Infection in humans is often asymptomatic, but it can manifest as an acute disease (usually a self-limited flu-like illness, pneumonia or hepatitis) or as a chronic form (mainly endocarditis, but also hepatitis and chronic-fatigue syndrome). In Tunisia, although prevalence of anti-Coxiella burnetii was high among blood donors, Q fever was rarely reported and frequently miss diagnosed by physicians. This study is a review of epidemiological and clinical particularities of Q fever in Tunisia.
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Affiliation(s)
- N Kaabia
- Service de médecine interne et maladies infectieuses, CHU Farhat-Hached, rue Mohamed-Karoui, 4000 Sousse, Tunisie.
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Acute Q fever in southern Taiwan: atypical manifestations of hyperbilirubinemia and prolonged fever. Diagn Microbiol Infect Dis 2008; 60:211-6. [DOI: 10.1016/j.diagmicrobio.2007.09.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2007] [Revised: 08/28/2007] [Accepted: 09/10/2007] [Indexed: 11/21/2022]
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Carrasco I, Arguis P, Miquel R, González-Martín J. Varón de 73 años con fiebre prolongada y alteración de las pruebas hepáticas. Med Clin (Barc) 2007; 128:111-7. [PMID: 17288926 DOI: 10.1016/s0025-7753(07)72503-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Ignasi Carrasco
- Servei de Medicina Interna, Hospital Municipal de Badalona, Badalona, Barcelona, Spain
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Ohguchi H, Hirabayashi Y, Kodera T, Ishii T, Munakata Y, Sasaki T. Q fever with clinical features resembling systemic lupus erythematosus. Intern Med 2006; 45:323-6. [PMID: 16596003 DOI: 10.2169/internalmedicine.45.1382] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 23-year-old woman with prolonged fever, rash, and pericarditis associated with high titers of antinuclear, anti-Sm, and anti-RNP antibodies was suspected of having systemic lupus erythematosus (SLE). However, we also considered infectious diseases, particularly Q fever, as the C-reactive protein level was elevated and the patient reported contact with zoo animals around two weeks before the onset. The condition responded rapidly to administration of minocycline; symptoms resolved without using steroids. Thereafter, no recurrence of the illness was observed. Titer of Coxiella burnetii antibody was high and the illness was accordingly diagnosed as acute Q fever rather than SLE.
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Affiliation(s)
- Hiroto Ohguchi
- Department of Rheumatology and Hematology, Graduate School of Medicine, Tohoku University, Sendai, Miyagi
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Camacho MT, Outschoorn I, Tellez A, Sequí J. Autoantibody profiles in the sera of patients with Q fever: characterization of antigens by immunofluorescence, immunoblot and sequence analysis. JOURNAL OF AUTOIMMUNE DISEASES 2005; 2:10. [PMID: 16280092 PMCID: PMC1298324 DOI: 10.1186/1740-2557-2-10] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2005] [Accepted: 11/10/2005] [Indexed: 11/18/2022]
Abstract
Recent reports have shown that some of the immunological aspects of Q fever, a rickettsiosis caused by Coxiella burnetii, could be related to self-antigen responses. The aim of this study was to determine the specificity of the autoantibody response of patients with acute and chronic Coxiella infections. Smooth muscle and cardiac muscle-specific autoantibodies were observed in significant percentages in acutely or chronically affected Q fever patients when compared to healthy volunteers. Moreover, the incidence of cardiac muscle-specific autoantibody was significantly higher among chronically ill patients compared to acutely ill patients. Moreover, a band of 50 kD of a HeLa extract was detected in most of the sera of individuals with chronic infections and previous sequence analysis suggests that this antigen presents a high degree of homology with the human actin elongation factor 1 alpha. Further research would be necessary to confirm if antibodies to human cytoskeletal proteins could be of clinical importance in chronically infected Q fever patients.
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Affiliation(s)
- MT Camacho
- Departamento de Orientación Diagnóstica. Centro Nacional de Microbiologia. Instituto de Salud Carlos III. Ctra. Majadahonda -Pozuelo Km 12,5. 28080-Madrid. Spain
| | - I Outschoorn
- Departamento de Respuesta Inmune. Centro Nacional de Microbiologia. Instituto de Salud Carlos III. Ctra. Majadahonda -Pozuelo Km 12,5. 28080-Madrid. Spain
| | - A Tellez
- Departamento de Orientación Diagnóstica. Centro Nacional de Microbiologia. Instituto de Salud Carlos III. Ctra. Majadahonda -Pozuelo Km 12,5. 28080-Madrid. Spain
| | - J Sequí
- Servicio de Inmunología. Hospital Carlos III. Imsalud. c/ Sinesio Delgado n° 10. 28029-Madrid. Spain
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Madariaga MG, Rezai K, Trenholme GM, Weinstein RA. Q fever: a biological weapon in your backyard. THE LANCET. INFECTIOUS DISEASES 2003; 3:709-21. [PMID: 14592601 DOI: 10.1016/s1473-3099(03)00804-1] [Citation(s) in RCA: 203] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Coxiella burnetii, which causes Q fever, is a highly infectious agent that is widespread among livestock around the world. Although the culture process for coxiella is laborious, large amounts of infectious material can be produced. If used as an aerosolised biological weapon, coxiella may not cause high mortality, but could provoke acute disabling disease. In its late course, Q fever can be complicated by fatal (eg, endocarditis) or debilitating (eg, chronic fatigue syndrome) disorders. The diagnosis of Q fever might be delayed because of non-specific and protean presentations. Effective antibiotic treatment is available for the acute form of disease but not for the chronic complications. Vaccination and chemoprophylaxis in selected individuals may be used in the event of bioterrorism.
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Affiliation(s)
- Miguel G Madariaga
- Division of Infectious Disease, Cook County Hospital, Chicago and the Section of Infectious Diseases, Rush-Presbyterian-St Luke's Medical Center, Chicago, IL 60612, USA.
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Alarcón AD, Villanueva JL, Viciana P, López-Cortés L, Torronteras R, Bernabeu M, Cordero E, Pachón J. Q fever: epidemiology, clinical features and prognosis. A study from 1983 to 1999 in the South of Spain. J Infect 2003; 47:110-6. [PMID: 12860143 DOI: 10.1016/s0163-4453(03)00013-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Clinical polymorphism is a main feature of Q fever and, depending upon the geographic location, differences in its clinical picture have been described. The objective of this study was to determine the epidemiology, clinical features and prognosis of acute Q fever in our area. METHODS From 1985 to 1999, consecutive cases of Q fever, presented as febrile syndrome and attended in a tertiary teaching hospital in Sevilla, Spain, were included and followed prospectively. RESULTS Two hundred and thirty-one cases of acute Q fever were included. A non-focalized febrile syndrome lasting from 7 to 28 days (fever of intermediate duration) was the most frequent presentation (n=208, 90%). One hundred and forty-eight patients had hepatitis. Overall, 53% of the cases were urban and contact with animals was referred in 39% of the patients. No relationship between clinical presentation and possible route of infection was observed. Prognosis was excellent (100% cured), although in 18 patients fever was prolonged more than 28 days and three patients developed life-threatening organ affection. Antimicrobial treatment was more effective if it was administered in the first two weeks (median defervescence of fever: 3 days versus 5.5 days, p<0.01). CONCLUSIONS Acute Q fever is a common cause of fever of intermediate duration, even in urban areas. Elevation of hepatic enzymes was the most frequent laboratory finding. Severe organ affection is uncommon and the overall prognosis of the disease is excellent. Early treatment seems to shorten the duration of the disease.
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Affiliation(s)
- Arístides de Alarcón
- Service of Infectious Diseases, University Hospitals Virgen del Rocío, Sevilla, Spain.
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Abstract
Q fever is a worldwide zoonosis caused by the strictly intracellular bacterium Coxiella burnetii. Among symptomatic patients (one-half of patients remain asymptomatic), acute Q fever most frequently manifests as a self-limited febrile illness, pneumonia, or hepatitis. Endocarditis is the predominant form of chronic Q fever. All the classical techniques of bacteriology may be used for diagnosis of C burnetii infection. Nonetheless, because of the risk of contamination, isolation must be performed in biosafety level 3 laboratories. Moreover, to date no diagnostic tests for detection by polymerase chain reaction or specific antibodies for immunochemistry are available commercially. Hence, Q fever is diagnosed in most cases by serology. The most reliable technique appears to be micro-immunofluorescence, which exhibits both good sensitivity and specificity. A wider use of this serology in cases of blood culture-negative endocarditis, atypical pneumonia, unexplained fever, and hepatitis should lead to an increase of diagnosed cases.
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Affiliation(s)
- Bernard La Scola
- Unité des Rickettsies, CNRS UMR 6020, Faculté de Médecine de Marseille, Marseille, France.
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Abstract
Ticks are effective vectors of viral, bacterial, rickettsial and parasitic diseases. Many of the tick-borne diseases (TBDs) are of significance to transfusion medicine, either because of the risks they pose to the blood supply or the necessity for blood products required in their treatment. The transmission of tick-borne pathogens via blood transfusion is of global concern. However, among transfusion medicine practitioners, experience with most of these microorganisms is limited. Transfusion transmission of TBDs has been documented largely by means of single case reports. A better understanding of the epidemiology, biology and management of this group of diseases is necessary in order to assess the risks they pose to the blood supply and to help guide effective prevention strategies to reduce this risk. Unique methods are required to focus on donor selection, predonation questioning, mass screening and inactivation or eradication procedures. The role of the transfusion medicine service in their treatment also needs to be better defined. This article reviews the growing body of literature pertaining to this emerging field of transfusion medicine and offers some recommendations for transfusionists in dealing with TBDs.
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Affiliation(s)
- L Pantanowitz
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
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Auzary C, Pinganaud C, Launay O, Joly V, Cremieux AC, Idatte JM, Carbon C. [Prosthetic valve endocarditis due to Coxiella burnetii: six cases]. Rev Med Interne 2001; 22:948-58. [PMID: 11695318 DOI: 10.1016/s0248-8663(01)00453-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Prosthetic valve endocarditis is a dangerous complication of valvular surgery (3-6%). Among involved pathogens, Coxiella burnetii is an occasional agent, though isolated with increasing frequency. We report our experience with this peculiar endocarditis and lay stress on specific diagnostic and therapeutic difficulties. METHODS Between 1990 and 1995, six patients retrospectively met the diagnosis criteria for definite endocarditis due to Coxiella burnetii. RESULTS Five Algerian men and one French woman presented with prosthetic valve endocarditis with negative blood cultures (on bioprosthesis: four cases, on mechanical valve: two cases). The main clinical and biological feature was febrile congestive heart failure with hepatomegaly, splenomegaly, hepatic and renal abnormalities, inflammatory syndrome, hypergammaglobulinemia, anemia and lymphopenia. Serological testing for Coxiella burnetii provided diagnosis in all cases. Echocardiography displayed vegetations in all cases. Valvular replacement was performed in four patients. With antibiotic therapy including doxycycline or/and hydroxychloroquine, quinolones or rifampicine, all patients experienced complete clinical, biological and echographic remission. CONCLUSION Q fever prosthetic valve endocarditis presents as a systemic disorder occurring in patients with valvular heart disease. From now on, early diagnosis and efficient medical treatment may provide permanent prosthetic sterilization.
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Affiliation(s)
- C Auzary
- Service de médecine interne, centre hospitalier de Moulins-Yzeure, 10, avenue du Général-de-Gaulle, BP 609, 03006 Moulins, France.
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Kubota H, Tanabe Y, Komiya T, Hirai K, Takanashi J, Kohno Y. Q fever encephalitis with cytokine profiles in serum and cerebrospinal fluid. Pediatr Infect Dis J 2001; 20:318-9. [PMID: 11303840 DOI: 10.1097/00006454-200103000-00022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 7-year-old boy with acute encephalitis was proved to have Coxiella burnetii infection. Cerebrospinal fluid but not serum had elevated values of interleukins 1-beta and 6, but not of tumor necrosis factor.
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Affiliation(s)
- H Kubota
- Department of Pediatrics, Faculty of Medicine, Chiba University, Japan.
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Abstract
The etiologic diagnosis of infective endocarditis is easily made in the presence of continuous bacteremia with gram-positive cocci. However, the blood culture may contain a bacterium rarely associated with endocarditis, such as Lactobacillus spp., Klebsiella spp., or nontoxigenic Corynebacterium, Salmonella, Gemella, Campylobacter, Aeromonas, Yersinia, Nocardia, Pasteurella, Listeria, or Erysipelothrix spp., that requires further investigation to establish the relationship with endocarditis, or the blood culture may be uninformative despite a supportive clinical evaluation. In the latter case, the etiologic agents are either fastidious extracellular or intracellular bacteria. Fastidious extracellular bacteria such as Abiotrophia, HACEK group bacteria, Clostridium, Brucella, Legionella, Mycobacterium, and Bartonella spp. need supplemented media, prolonged incubation time, and special culture conditions. Intracellular bacteria such as Coxiella burnetii cannot be isolated routinely. The two most prevalent etiologic agents of culture-negative endocarditis are C. burnetti and Bartonella spp. Their diagnosis is usually carried out serologically. A systemic pathologic examination of excised heart valves including periodic acid-Schiff (PAS) staining and molecular methods has allowed the identification of Whipple's bacillus endocarditis. Pathologic examination of the valve using special staining, such as Warthin-Starry, Gimenez, and PAS, and broad-spectrum PCR should be performed systematically when no etiologic diagnosis is evident through routine laboratory evaluation.
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Affiliation(s)
- P Brouqui
- Unité des Rickettsies, CNRS UPRESA 6020, Faculté de Médecine, 13385 Marseille Cedex 5, France.
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Ariga T, Nagaoka H, Miyanoshita A, Kusunoki Y, Watanabe T, Shinohara T, Sakiyama Y. Coxiella burnetii lymphadenitis: a possible fever focus in acute Q fever. Pediatr Int 2000; 42:711-4. [PMID: 11192537 DOI: 10.1046/j.1442-200x.2000.01290.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- T Ariga
- Department of Pediatrics, Teine Keijinkai Hospital, Sapporo, Japan.
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Hervás JA, de la Fuente MA, García F, Reynés J, de Carlos JC, Salvá F. Coxiella burnetii myopericarditis and rhabdomyolysis in a child. Pediatr Infect Dis J 2000; 19:1104-6. [PMID: 11099098 DOI: 10.1097/00006454-200011000-00019] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- J A Hervás
- Department of Pediatrics, Son Dureta University Hospital, Palma de Mallorca, Spain
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Q-fever presenting with intractable diarrhea and fever with both responding to indomethacin. ACTA ACUST UNITED AC 2000. [DOI: 10.1016/s1069-417x(00)89006-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Raoult D, Tissot-Dupont H, Foucault C, Gouvernet J, Fournier PE, Bernit E, Stein A, Nesri M, Harle JR, Weiller PJ. Q fever 1985-1998. Clinical and epidemiologic features of 1,383 infections. Medicine (Baltimore) 2000; 79:109-23. [PMID: 10771709 DOI: 10.1097/00005792-200003000-00005] [Citation(s) in RCA: 352] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
In order to describe the clinical features and the epidemiologic findings of 1,383 patients hospitalized in France for acute or chronic Q fever, we conducted a retrospective analysis based on 74,702 sera tested in our diagnostic center, National Reference Center and World Health Organization Collaborative Center for Rickettsial Diseases. The physicians in charge of all patients with evidence of acute Q fever (seroconversion and/or presence of IgM) or chronic Q fever (prolonged disease and/or IgG antibody titer to phase I of Coxiella burnetii > or = 800) were asked to complete a questionnaire, which was computerized. A total of 1,070 cases of acute Q fever was recorded. Males were more frequently diagnosed, and most cases were identified in the spring. Cases were observed more frequently in patients between the ages of 30 and 69 years. We classified patients according to the different clinical forms of acute Q fever, hepatitis (40%), pneumonia and hepatitis (20%), pneumonia (17%), isolated fever (17%), meningoencephalitis (1%), myocarditis (1%), pericarditis (1%), and meningitis (0.7%). We showed for the first time, to our knowledge, that different clinical forms of acute Q fever are associated with significantly different patient status. Hepatitis occurred in younger patients, pneumonia in older and more immunocompromised patients, and isolated fever was more common in female patients. Risk factors were not specifically associated with a clinical form except meningoencephalitis and contact with animals. The prognosis was usually good except for those with myocarditis or meningoencephalitis as 13 patients died who were significantly older than others. For chronic Q fever, antibody titers to C. burnetii phase I above 800 and IgA above 50 were predictive in 94% of cases. Among 313 patients with chronic Q fever, 259 had endocarditis, mainly patients with previous valvulopathy; 25 had an infection of vascular aneurysm or prosthesis. Patients with endocarditis or vascular infection were more frequently immunocompromised and older than those with acute Q fever. Fifteen women were infected during pregnancy; they were significantly more exposed to animals and gave birth to only 5 babies, only 2 with a normal birth weight. More rare manifestations observed were chronic hepatitis (8 cases), osteoarticular infection (7 cases), and chronic pericarditis (3 cases). Nineteen patients were observed who experienced first a documented acute infection, then, due to underlying conditions, a chronic infection. To our knowledge, we report the largest series of Q fever to date. Our results indicate that Q fever is a protean disease, grossly underestimated, with some of the clinical manifestations being only recently reported, such as Q fever during pregnancy, chronic vascular infection, osteomyelitis, pericarditis, and myocarditis. Our data confirm that chronic Q fever is mainly determined by host factors and demonstrate for the first time that host factors may also play a role in the clinical expression of acute Q fever.
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Affiliation(s)
- D Raoult
- Unité des Rickettsies, Université de la Méditerranée, Marseille, France.
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Granel B, Genty I, Serratrice J, Rey J, Disdier P, Raoult D, Weiller PJ. Livedo reticularis revealing a latent infective endocarditis due to Coxiella burnetti. J Am Acad Dermatol 1999; 41:842-4. [PMID: 10534665 DOI: 10.1016/s0190-9622(99)70340-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We report the first case of livedo reticularis revealing a latent infective endocarditis due to Coxiella burnetti. The patient, a 54-year-old woman, also had chronic thrombocytopenia and mixed cryoglobulinemia. Chronic Q fever was confirmed by serodiagnosis and livedo regressed totally with doxycycline and hydroxychloroquine.
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Affiliation(s)
- B Granel
- Service de Médecine Interne, Hôpital de la Timone, Marseille, France
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Anomalies immunologiques au cours des infections à Coxiella burnetii. Étude personnelle et revue de la littérature. Med Mal Infect 1999. [DOI: 10.1016/s0399-077x(00)87140-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
Q fever is a zoonosis with a worldwide distribution with the exception of New Zealand. The disease is caused by Coxiella burnetii, a strictly intracellular, gram-negative bacterium. Many species of mammals, birds, and ticks are reservoirs of C. burnetii in nature. C. burnetii infection is most often latent in animals, with persistent shedding of bacteria into the environment. However, in females intermittent high-level shedding occurs at the time of parturition, with millions of bacteria being released per gram of placenta. Humans are usually infected by contaminated aerosols from domestic animals, particularly after contact with parturient females and their birth products. Although often asymptomatic, Q fever may manifest in humans as an acute disease (mainly as a self-limited febrile illness, pneumonia, or hepatitis) or as a chronic disease (mainly endocarditis), especially in patients with previous valvulopathy and to a lesser extent in immunocompromised hosts and in pregnant women. Specific diagnosis of Q fever remains based upon serology. Immunoglobulin M (IgM) and IgG antiphase II antibodies are detected 2 to 3 weeks after infection with C. burnetii, whereas the presence of IgG antiphase I C. burnetii antibodies at titers of >/=1:800 by microimmunofluorescence is indicative of chronic Q fever. The tetracyclines are still considered the mainstay of antibiotic therapy of acute Q fever, whereas antibiotic combinations administered over prolonged periods are necessary to prevent relapses in Q fever endocarditis patients. Although the protective role of Q fever vaccination with whole-cell extracts has been established, the population which should be primarily vaccinated remains to be clearly identified. Vaccination should probably be considered in the population at high risk for Q fever endocarditis.
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Affiliation(s)
- M Maurin
- Unité des Rickettsies, CNRS UPRES A 6020, Université de la Méditerranée, Faculté de Médecine, 13385 Marseilles Cedex 5, France
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Affiliation(s)
- S Vignes
- Service de médecine interne, hôpital Saint-Louis, Paris
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