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Melenotte C, Protopopescu C, Million M, Edouard S, Carrieri MP, Eldin C, Angelakis E, Djossou F, Bardin N, Fournier PE, Mège JL, Raoult D. Clinical Features and Complications of Coxiella burnetii Infections From the French National Reference Center for Q Fever. JAMA Netw Open 2018; 1:e181580. [PMID: 30646123 PMCID: PMC6324270 DOI: 10.1001/jamanetworkopen.2018.1580] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
IMPORTANCE Q fever remains widespread throughout the world; the disease is serious and causes outbreaks and deaths when complications are not detected. The diagnosis of Q fever requires the demonstration of the presence of Coxiella burnetii and the identification of an organic lesion. OBJECTIVE To describe the hitherto neglected clinical characteristics of Q fever and identifying risk factors for complications and death. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study conducted from January 1, 1991, through December 31, 2016, included patients treated at the French National Reference Center for Q fever with serologic findings positive for C burnetii and clinical data consistent with C burnetii infection. Clinical data were prospectively collected by telephone. Patients with unavailable clinical data or an unidentified infectious focus were excluded. MAIN OUTCOMES AND MEASURES Q fever complications and mortality. RESULTS Of the 180 483 patients undergoing testing, 2918 had positive findings for C burnetii and 2434 (68.8% men) presented with clinical data consistent with a C burnetii infection. Mean (SD) age was 51.8 (17.4) years, and the ratio of men to women was 2.2. At the time of inclusion, 1806 patients presented with acute Q fever, including 138 with acute Q fever that progressed to persistent C burnetii infection, and 766 had persistent focalized C burnetii infection. Rare and hitherto neglected foci of infections included lymphadenitis (97 [4.0%]), acute Q fever endocarditis (50 [2.1%]), hemophagocytic syndrome (9 [0.4%]), and alithiasic cholecystitis (11 [0.4%]). Vascular infection (hazard ratio [HR], 3.1; 95% CI, 1.7-5.7; P < .001) and endocarditis (HR, 2.4; 95% CI, 1.1-5.1; P = .02) were associated with an increased risk of death. Independent indicators of lymphoma were lymphadenitis (HR, 77.4; 95% CI, 21.2-281.8; P < .001) and hemophagocytic syndrome (HR, 19.1; 95% CI, 3.4-108.6; P < .001). The presence of anticardiolipin antibodies during acute Q fever has been associated with several complications, including hepatitis, cholecystitis, endocarditis, thrombosis, hemophagocytic syndrome, meningitis, and progression to persistent endocarditis. CONCLUSIONS AND RELEVANCE Previously neglected foci of C burnetii infection include the lymphatic system (ie, bone marrow, lymphadenitis) with a risk of lymphoma. Cardiovascular infections were the main fatal complications, highlighting the importance of routine screening for valvular heart disease and vascular anomalies during acute Q fever. Routine screening for anticardiolopin antibodies during acute Q fever can help prevent complications. Positron emission tomographic scanning could be proposed for all patients with suspected persistent focused infection to rapidly diagnose vascular and lymphatic infections associated with death and lymphoma, respectively.
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Affiliation(s)
- Cléa Melenotte
- Aix-Marseille University, Institut de Recherche pour le Développement (IRD), Assistance Publique Hôpitaux de Marseille (APHM), Microbes, Evolution, Phylogénie et Infections, IHU (Institut Hospitalo-Universitaire)–Méditerranée Infection, Marseille, France
- French Reference Center for the Diagnosis and Study of Rickettsioses, Q Fever and Bartonelloses, IHU–Méditerranée Infection, Marseille, France
| | - Camélia Protopopescu
- Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Medicale, IRD, Sciences Economiques et Sociales de la Santé et Traitement de l’Information Médicale, Marseille, France
| | - Matthieu Million
- Aix-Marseille University, Institut de Recherche pour le Développement (IRD), Assistance Publique Hôpitaux de Marseille (APHM), Microbes, Evolution, Phylogénie et Infections, IHU (Institut Hospitalo-Universitaire)–Méditerranée Infection, Marseille, France
- French Reference Center for the Diagnosis and Study of Rickettsioses, Q Fever and Bartonelloses, IHU–Méditerranée Infection, Marseille, France
| | - Sophie Edouard
- Aix-Marseille University, Institut de Recherche pour le Développement (IRD), Assistance Publique Hôpitaux de Marseille (APHM), Microbes, Evolution, Phylogénie et Infections, IHU (Institut Hospitalo-Universitaire)–Méditerranée Infection, Marseille, France
- French Reference Center for the Diagnosis and Study of Rickettsioses, Q Fever and Bartonelloses, IHU–Méditerranée Infection, Marseille, France
| | - M. Patrizia Carrieri
- Aix-Marseille University, Institut de Recherche pour le Développement (IRD), Assistance Publique Hôpitaux de Marseille (APHM), Microbes, Evolution, Phylogénie et Infections, IHU (Institut Hospitalo-Universitaire)–Méditerranée Infection, Marseille, France
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Medicale, IRD, Sciences Economiques et Sociales de la Santé et Traitement de l’Information Médicale, Marseille, France
| | - Carole Eldin
- Aix-Marseille University, Institut de Recherche pour le Développement (IRD), Assistance Publique Hôpitaux de Marseille (APHM), Microbes, Evolution, Phylogénie et Infections, IHU (Institut Hospitalo-Universitaire)–Méditerranée Infection, Marseille, France
- French Reference Center for the Diagnosis and Study of Rickettsioses, Q Fever and Bartonelloses, IHU–Méditerranée Infection, Marseille, France
| | - Emmanouil Angelakis
- Aix-Marseille University, Institut de Recherche pour le Développement (IRD), Assistance Publique Hôpitaux de Marseille (APHM), Microbes, Evolution, Phylogénie et Infections, IHU (Institut Hospitalo-Universitaire)–Méditerranée Infection, Marseille, France
- French Reference Center for the Diagnosis and Study of Rickettsioses, Q Fever and Bartonelloses, IHU–Méditerranée Infection, Marseille, France
| | - Félix Djossou
- Unité de Maladies Infectieuses et Tropicales, Centre Hospitalier André Rosemon, Cayenne, Guyane Française
| | - Nathalie Bardin
- Aix-Marseille University, Institut de Recherche pour le Développement (IRD), Assistance Publique Hôpitaux de Marseille (APHM), Microbes, Evolution, Phylogénie et Infections, IHU (Institut Hospitalo-Universitaire)–Méditerranée Infection, Marseille, France
- Immunology Laboratory, APHM, Centre Hospitalier Universitaire Conception, Marseille, France
| | - Pierre-Edouard Fournier
- Aix-Marseille University, Institut de Recherche pour le Développement (IRD), Assistance Publique Hôpitaux de Marseille (APHM), Microbes, Evolution, Phylogénie et Infections, IHU (Institut Hospitalo-Universitaire)–Méditerranée Infection, Marseille, France
- French Reference Center for the Diagnosis and Study of Rickettsioses, Q Fever and Bartonelloses, IHU–Méditerranée Infection, Marseille, France
| | - Jean-Louis Mège
- Aix-Marseille University, Institut de Recherche pour le Développement (IRD), Assistance Publique Hôpitaux de Marseille (APHM), Microbes, Evolution, Phylogénie et Infections, IHU (Institut Hospitalo-Universitaire)–Méditerranée Infection, Marseille, France
- Immunology Laboratory, APHM, Centre Hospitalier Universitaire Conception, Marseille, France
| | - Didier Raoult
- Aix-Marseille University, Institut de Recherche pour le Développement (IRD), Assistance Publique Hôpitaux de Marseille (APHM), Microbes, Evolution, Phylogénie et Infections, IHU (Institut Hospitalo-Universitaire)–Méditerranée Infection, Marseille, France
- French Reference Center for the Diagnosis and Study of Rickettsioses, Q Fever and Bartonelloses, IHU–Méditerranée Infection, Marseille, France
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