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Meriglier E, Asquier L, Roblot F, Roblot P, Landron C. A case of Q fever with erythema nodosum. Infection 2017; 46:127-129. [PMID: 28819912 DOI: 10.1007/s15010-017-1058-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 08/03/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Acute Q fever is asymptomatic in 60% of the patients, while the reminder may present with fever, pneumoniae, and hepatitis. Skin manifestations are uncommon including transient punctiform rashes, purpuric, or maculopapular eruptions. Erythema nodosum have seldom been reported. CASE PRESENTATION A 37-year-old female presented with fever for 1 month and skin lesions consists of erythematous painful nodule of the legs. Serological testing for Coxiella burnetii was positive. Treatment consisted with doxycycline for 2 weeks. Evolution was favorable. The patient completely recovered and had no evidence of skin lesion 1 month later. CONCLUSION Because of its nonspecific clinical presentation, Q fever with erythema nodosum is probably underestimated. Q fever should be evocated when facing unexplained erythema nodosum even if there is not other typical clinical manifestation of Q fever.
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Affiliation(s)
- E Meriglier
- Department of Internal Medicine, Centre hospitalier universitaire de Poitiers, 2 Rue de la milétrie, 86000, Poitiers, France. .,Department of infectious diseases, Centre hospitalier universitaire de Poitiers, 2 Rue de la milétrie, 86000, Poitiers, France.
| | - L Asquier
- Emergency unit, Centre hospitalier de La Rochelle, Rue du Dr Schweitzer, 17000, La Rochelle, France
| | - F Roblot
- Department of infectious diseases, Centre hospitalier universitaire de Poitiers, 2 Rue de la milétrie, 86000, Poitiers, France
| | - P Roblot
- Department of Internal Medicine, Centre hospitalier universitaire de Poitiers, 2 Rue de la milétrie, 86000, Poitiers, France
| | - C Landron
- Department of Internal Medicine, Centre hospitalier universitaire de Poitiers, 2 Rue de la milétrie, 86000, Poitiers, France
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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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Bart IY, Schabos Y, van Hout RWNM, Leenders ACAP, de Vries E. Pediatric acute Q fever mimics other common childhood illnesses. PLoS One 2014; 9:e88677. [PMID: 24520412 PMCID: PMC3919820 DOI: 10.1371/journal.pone.0088677] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 01/08/2014] [Indexed: 11/25/2022] Open
Abstract
Knowledge of Q fever has increased over the last decades, but research has mainly focused on adults. Data in children are scarce, and current knowledge is mostly based on case reports. The aim of this study was to determine predictors for acute Q fever in children in the general population. We retrospectively studied all children tested for Coxiella burnetii by serology and/or PCR upon request of their general practitioner in the regional laboratory for Medical Microbiology of the Jeroen Bosch during the Q fever outbreak in the Netherlands between 2007 and 2011. A total of 1061 patients was analyzed. Influenza-like illness and respiratory tract infection were the most common presentations of acute Q fever, mimicking other common childhood illnesses. None of the reported symptoms was significantly related to a positive test outcome and therefore presenting signs or symptoms have no predictive value in diagnosing Q-fever in children. Only diagnostic tests are reliable. As the infection generally follows a mild and uncomplicated course, we question if the difficulty of recognizing pediatric Q fever is a problem worth solving.
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Affiliation(s)
- Ingeborg Y. Bart
- Department of Pediatrics, Jeroen Bosch Hospital’s-Hertogenbosch, The Netherlands
| | - Yvonne Schabos
- Department of Pediatrics, Jeroen Bosch Hospital’s-Hertogenbosch, The Netherlands
| | | | | | - Esther de Vries
- Department of Pediatrics, Jeroen Bosch Hospital’s-Hertogenbosch, The Netherlands
- * E-mail:
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Gunn TM, Raz GM, Turek JW, Farivar RS. Cardiac Manifestations of Q Fever Infection: Case Series and a Review of the Literature. J Card Surg 2013; 28:233-7. [DOI: 10.1111/jocs.12098] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Tyler M. Gunn
- Department of Cardiothoracic Surgery; University of Iowa Carver College of Medicine; Iowa City, Iowa
| | - Guy M. Raz
- Department of Cardiothoracic Surgery; University of Iowa Carver College of Medicine; Iowa City, Iowa
| | - Joseph W. Turek
- Department of Cardiothoracic Surgery; University of Iowa Carver College of Medicine; Iowa City, Iowa
| | - Robert Saeid Farivar
- Division of Cardiothoracic Surgery; University of Pennsylvania Perelman School of Medicine; Philadelphia, Pennsylvania
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Cutaneous manifestations of category A bioweapons. J Am Acad Dermatol 2011; 65:1213.e1-1213.e15. [DOI: 10.1016/j.jaad.2010.08.040] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Revised: 08/06/2010] [Accepted: 08/06/2010] [Indexed: 11/22/2022]
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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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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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Raoult D, Marrie T, Mege J. Natural history and pathophysiology of Q fever. THE LANCET. INFECTIOUS DISEASES 2005; 5:219-26. [PMID: 15792739 DOI: 10.1016/s1473-3099(05)70052-9] [Citation(s) in RCA: 489] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Q fever is a zoonosis caused by Coxiella burnetii. Infection with C burnetii can be acute or chronic, and exhibits a wide spectrum of clinical manifestations. The extreme infectivity of the bacterium results in large outbreaks and makes it a potential bioweapon. In the past decade, the complete genome sequencing of C burnetii, the exploration of bacterial interactions with the host, and the description of the natural history of the disease in human beings and in experimental models have all added to our knowledge about this fascinating disease. Advances in understanding the pathophysiology and natural history of Q fever are reviewed.
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Affiliation(s)
- D Raoult
- Unité des Rickettsies, CNRS UMR 6020, Faculté de Médecine, Université de la Méditerranée, Marseille, France.
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Abstract
Ticks are ectoparasites that cause dermatologic disease directly by their bite and indirectly as vectors of bacterial, rickettsial, protozoal, and viral diseases. In North America, where ticks are the leading cause of vector-borne infection, dermatologists should recognize several tick species. Basic tick biology and identification will be reviewed. Tick bites cause a variety of acute and chronic skin lesions. The tick-borne diseases include Lyme disease, tick-borne relapsing fever, tularemia, babesiosis, Rocky Mountain spotted fever, other spotted fevers, ehrlichiosis, Colorado tick fever, and others. The epidemiology, clinical features, diagnosis, and treatment of these diseases are reviewed with an emphasis on cutaneous manifestations. Finally, the prevention of diseases caused by ticks is reviewed.
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