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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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Melenotte C, Izaaryene JJ, Gomez C, Delord M, Prudent E, Lepidi H, Mediannikov O, Lacoste M, Djossou F, Mania A, Bernard N, Huchot E, Mège JL, Brégeon F, Raoult D. Coxiella burnetii: A Hidden Pathogen in Interstitial Lung Disease? Clin Infect Dis 2018; 67:1120-1124. [DOI: 10.1093/cid/ciy278] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 04/05/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Cléa Melenotte
- IRD, Assistance Publique des Hôpitaux de Marseille (APHM), MEPHI, Institut Hospitalo-Universitaire-Méditerranée Infection, Aix-Marseille Université
| | | | - Carine Gomez
- Service de Pneumologie et Transplantation Pulmonaire, Centre de Compétences des Maladies Rares Pulmonaires et de l’Hypertension Pulmonaire, Centre Hospitalo Universitaire (CHU) Nord de Marseille, Aix-Marseille Université
| | - Marion Delord
- IRD, Assistance Publique des Hôpitaux de Marseille (APHM), MEPHI, Institut Hospitalo-Universitaire-Méditerranée Infection, Aix-Marseille Université
| | - Elsa Prudent
- IRD, Assistance Publique des Hôpitaux de Marseille (APHM), MEPHI, Institut Hospitalo-Universitaire-Méditerranée Infection, Aix-Marseille Université
| | - Hubert Lepidi
- IRD, Assistance Publique des Hôpitaux de Marseille (APHM), MEPHI, Institut Hospitalo-Universitaire-Méditerranée Infection, Aix-Marseille Université
| | - Oleg Mediannikov
- IRD, Assistance Publique des Hôpitaux de Marseille (APHM), MEPHI, Institut Hospitalo-Universitaire-Méditerranée Infection, Aix-Marseille Université
| | - Marion Lacoste
- Centre Hospitalier de Troyes, Service de Médecine Interne et Maladies Infectieuses
| | - Felix Djossou
- Centre Hospitalier André Rosemon de Cayenne, Unité de Maladies Infectieuses et Tropicales
| | - Alexandre Mania
- Service de Médecine Interne, Centre Hospitalier Universitaire de Clermont-Ferrand Gabriel-Montpied, France
| | - Noelle Bernard
- Service de Médecine Interne et Maladies Infectieuse, Hôpital Saint André, Assistance Publique des Hôpitaux de Paris, France
| | - Eric Huchot
- Centre Hospitalier de la Réunion, Service de Pneumologie, Saint Pierre, France
| | - Jean-Louis Mège
- IRD, Assistance Publique des Hôpitaux de Marseille (APHM), MEPHI, Institut Hospitalo-Universitaire-Méditerranée Infection, Aix-Marseille Université
| | - Fabienne Brégeon
- IRD, Assistance Publique des Hôpitaux de Marseille (APHM), MEPHI, Institut Hospitalo-Universitaire-Méditerranée Infection, Aix-Marseille Université
- Service d’Explorations Fonctionnelles Respiratoires, Pôle CVT 16, CHU Nord, APHM, Marseille, France
| | - Didier Raoult
- IRD, Assistance Publique des Hôpitaux de Marseille (APHM), MEPHI, Institut Hospitalo-Universitaire-Méditerranée Infection, Aix-Marseille Université
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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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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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Poliadenitis como forma infrecuente de presentación de fiebre Q aguda. Enferm Infecc Microbiol Clin 2016; 34:74-6. [DOI: 10.1016/j.eimc.2014.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 11/13/2014] [Accepted: 11/21/2014] [Indexed: 11/23/2022]
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Konstantinov KN, Emil SN, Barry M, Kellie S, Tzamaloukas AH. Glomerular disease in patients with infectious processes developing antineutrophil cytoplasmic antibodies. ISRN NEPHROLOGY 2013; 2013:324315. [PMID: 24959541 PMCID: PMC4045435 DOI: 10.5402/2013/324315] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 11/06/2012] [Indexed: 12/21/2022]
Abstract
To identify differences in treatment and outcome of various types of glomerulonephritis developing in the course of infections triggering antineutrophil cytoplasmic antibody (ANCA) formation, we analyzed published reports of 50 patients. Immunosuppressives were added to antibiotics in 22 of 23 patients with pauci-immune glomerulonephritis. Improvement was noted in 85% of 20 patients with information on outcomes. Death rate was 13%. Corticosteroids were added to antibiotics in about 50% of 19 patients with postinfectious glomerulonephritis. Improvement rate was 74%, and death rate was 26%. Two patients with mixed histological features were analyzed under both pauci-immune and post-infectious glomerulonephritis categories. In 9 patients with other renal histology, treatment consisted of antibiotics alone (7 patients), antibiotics plus immunosuppressives (1 patient), or immunosuppressives alone (1 patient). Improvement rate was 67%, permanent renal failure rate was 22%, and death rate was 11%. One patient with antiglomerular basement disease glomerulonephritis required maintenance hemodialysis. Glomerulonephritis developing in patients who became ANCA-positive during the course of an infection is associated with significant mortality. The histological type of the glomerulonephritis guides the choice of treatment. Pauci-immune glomerulonephritis is usually treated with addition of immunosuppressives to antibiotics.
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Affiliation(s)
- Konstantin N. Konstantinov
- Division of Rheumatology, Department of Medicine, Raymond G. Murphy VA Medical Center, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA
| | - Suzanne N. Emil
- Division of Rheumatology, Department of Medicine, Raymond G. Murphy VA Medical Center, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA
| | - Marc Barry
- Department of Pathology, University of New Mexico School of Medicine, MSC08 4640, BMSB, Room 335, University of New Mexico, Albuquerque, NM 87131, USA
| | - Susan Kellie
- Division of Infectious Diseases, Department of Medicine, Raymond G. Murphy VA Medical Center, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA
| | - Antonios H. Tzamaloukas
- Division of Nephrology, Department of Medicine, Raymond G. Murphy VA Medical Center, University of New Mexico School of Medicine, VA Medical Center (111C), 1501 San Pedro, SE, Albuquerque, NM 87131, USA
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