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Ghanem-Zoubi N, Mustafa-Hellou M, Zahran M, Gazit L, Shalaginov R, Dabaja-Younis H, Szwarcwort M. The integration of Coxiella burnetii PCR testing in serum into the diagnostic algorithm of suspected acute Q fever in an endemic setting. J Clin Microbiol 2024; 62:e0170323. [PMID: 38470022 PMCID: PMC11005359 DOI: 10.1128/jcm.01703-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 02/21/2024] [Indexed: 03/13/2024] Open
Abstract
Serum polymerase chain reaction (PCR) for the detection of Coxiella burnetii DNA has been suggested for rapid Q fever diagnosis. We evaluated the role of PCR testing in serum in the diagnosis of acute Q fever in an endemic setting. We examined patients suspected of acute Q fever tested for C. burnetii-specific serum real-time PCR in a tertiary hospital between January 2019 toand December 2022. In the first half, PCR orders were consultation-based by infectious diseases specialists, while in the second half, they were guided by serology, positive IgM2, and negative IgG1 and IgG2, indicating early acute infection. Logistic regression analyzed independent predictors for positive PCR. PCR positivity rates were calculated using various clinical criteria in the diagnostic algorithm. Out of 272 patients, 13 (4.8%) tested positive and 130 exhibited serologically suspected early infection. Presentation during April-July and aspartate aminotransferase (AST) > 3× upper normal limit (UNL) were independently associated with positive PCR with an odds ratio (OR) = 15.03 [95% confidence interval (CI), 1.58-142.46], P = 0.018 and OR = 55.44 [95% CI, 6.16-498.69], P < 0.001, respectively. PCR positivity rate was 8.5% in serologically suspected early infection vs 1.4% in other serology, yielding OR = 6.4 [95% CI, 1.4-29.7], P = 0.009. Adding AST > 3× UNL increased OR to 49.5 [95% CI, 5.9-408.7], P ≤ 0.001 reducing required PCR tests for a single acute Q fever case from 11.8 to 3. Elevated AST in serologically suspected early Q fever is proposed to be used in a diagnostic stewardship algorithm integrating PCR in serum in an endemic setting. IMPORTANCE Our study suggests in a diagnostic stewardship approach the integration of molecular testing (Coxiella burnetii targeted PCR) for the diagnosis of acute Q fever in a reliable time in the endemic setting. Integrating PCR detecting Coxiella burnetii in serum in routine testing of suspected early acute Q fever based on serology result increased the PCR positivity rate significantly. Adding increased transaminases optimizes PCR utility which is highly requested particularly in endemic areas.
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Affiliation(s)
- Nesrin Ghanem-Zoubi
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | | | - Maram Zahran
- Department of Medicine A, Rambam Health Care Campus, Haifa, Israel
| | - Liat Gazit
- Microbiology Laboratory, Rambam Health Care Campus, Haifa, Israel
| | - Raya Shalaginov
- Microbiology Laboratory, Rambam Health Care Campus, Haifa, Israel
| | - Halima Dabaja-Younis
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
- Pediatric Infectious Diseases Unit, Rambam Health Care Campus, Haifa, Israel
| | - Moran Szwarcwort
- Microbiology Laboratory, Rambam Health Care Campus, Haifa, Israel
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Aubin A, Eldin C, Zemali N, Jaubert J, Koumar Y, Moiton MP, Poubeau P, Braunberger E, Gérardin P, Bertolotti A. Clinical and Epidemiological Aspects of Acute Q Fever in Reunion Island over Fourteen Years: A Retrospective Cohort Study. Microorganisms 2023; 11:2485. [PMID: 37894143 PMCID: PMC10609548 DOI: 10.3390/microorganisms11102485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/26/2023] [Accepted: 10/02/2023] [Indexed: 10/29/2023] Open
Abstract
The clinical characteristics and epidemiology of Q fever in the Tropics are poorly described. We performed a retrospective cohort study of hospitalized cases between 2004 and 2017 in Reunion Island. Acute Q fever was defined in presence of a positive serology (phase II IgG ≥ 200 and phase II IgM ≥ 50), or a seroconversion (4-fold increase in phase II IgG between paired samples), or a positive PCR (blood or serum). Forty-two cases matched the diagnostic criteria. The most common clinical manifestations were fever (85.7%) and pulmonary symptoms (61.9%), including pneumonia (45.2%). Ninety percent of the patients were living in a farming area. Cumulative incidence was estimated at 9.3 per 100,000 inhabitants (95%CI: 6.4-12.1) with cases diagnosed yearly all throughout the study period except in 2006. Together with the seroprevalence figures, these data suggest that Q fever reaches low to moderate endemic levels on Reunion Island. As previously reported, pulmonary symptoms are in the foreground.
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Affiliation(s)
- Alexandra Aubin
- Service des Maladies Infectieuses—Dermatologie, Centre Hospitalier Universitaire (CHU) Réunion, BP 350, 97448 Saint Pierre, La Réunion, France; (A.A.); (Y.K.); (A.B.)
| | - Carole Eldin
- Comité de Lutte Contre les Infections Nosocomiales (CLIN), Hôpital Nord, Chemin des Bourrély, 13015 Marseille, France
- Unité des Virus Emergents (UVE), Aix-Marseille Université, IRD 190 INSERM 1207 EFS-IRBA, 13005 Marseille, France
| | - Naël Zemali
- Laboratoire de Microbiologie, CHU Réunion, BP 350, 97448 Saint Pierre, La Réunion, France (J.J.)
| | - Julien Jaubert
- Laboratoire de Microbiologie, CHU Réunion, BP 350, 97448 Saint Pierre, La Réunion, France (J.J.)
| | - Yatrika Koumar
- Service des Maladies Infectieuses—Dermatologie, Centre Hospitalier Universitaire (CHU) Réunion, BP 350, 97448 Saint Pierre, La Réunion, France; (A.A.); (Y.K.); (A.B.)
| | - Marie-Pierre Moiton
- Service des Maladies Infectieuses-Médecine Interne, CHU Réunion, 97400 Saint Denis, La Réunion, France;
| | - Patrice Poubeau
- Service des Maladies Infectieuses—Dermatologie, Centre Hospitalier Universitaire (CHU) Réunion, BP 350, 97448 Saint Pierre, La Réunion, France; (A.A.); (Y.K.); (A.B.)
| | - Eric Braunberger
- Service de Chirurgie Thoracique, CHU Réunion, 97400 Saint Denis, La Réunion, France
| | - Patrick Gérardin
- Inserm CIC1410, CHU Réunion, BP 350, 97448 Saint Pierre, La Réunion, France;
| | - Antoine Bertolotti
- Service des Maladies Infectieuses—Dermatologie, Centre Hospitalier Universitaire (CHU) Réunion, BP 350, 97448 Saint Pierre, La Réunion, France; (A.A.); (Y.K.); (A.B.)
- Inserm CIC1410, CHU Réunion, BP 350, 97448 Saint Pierre, La Réunion, France;
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Li D, Liu H, Liu M, Chang C, Zhao X, Yu H, Yan L, Han H, Yu XJ. Delayed Diagnosis of Acute Q Fever, China. Emerg Infect Dis 2022; 28:2580-2582. [PMID: 36418013 PMCID: PMC9707575 DOI: 10.3201/eid2812.221118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
We report a patient in China with fever of unknown origin who visited 3 hospitals in 3 weeks and was finally given a diagnosis of acute Q fever, determined by metagenomics next-generation sequencing. Our results indicate that physicians are unfamiliar with Q fever and the disease is neglected in China.
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Uribe Pulido N, Escorcia García C, Cabrera Orrego R, Gutiérrez LA, Agudelo CA. Acute Q Fever With Dermatologic Manifestations, Molecular Diagnosis, and No Seroconversion. Open Forum Infect Dis 2021; 8:ofab458. [PMID: 34692888 PMCID: PMC8530256 DOI: 10.1093/ofid/ofab458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 09/06/2021] [Indexed: 11/14/2022] Open
Abstract
We herein described a case of acute infection by Coxiella burnetii (acute Q fever) that started with a short incubation period and showed prominent dermatological manifestations and unusual serological behavior. The infection was confirmed by molecular detection through real-time polymerase chain reaction using genomic DNA collected from peripheral blood.
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Affiliation(s)
| | | | - Ruth Cabrera Orrego
- Grupo Biología de Sistemas, Escuela de Ciencias de la Salud, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Lina Andrea Gutiérrez
- Grupo Biología de Sistemas, Escuela de Ciencias de la Salud, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Carlos Andrés Agudelo
- Clínica Universitaria Bolivariana, Medellín, Colombia
- Escuela de Ciencias de la Salud, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
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Buijs SB, Bleeker-Rovers CP, van Roeden SE, Kampschreur LM, Hoepelman AIM, Wever PC, Oosterheert JJ. Still new chronic Q fever cases diagnosed eight years after a large Q fever outbreak. Clin Infect Dis 2021; 73:1476-1483. [PMID: 34028546 DOI: 10.1093/cid/ciab476] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Chronic Q fever usually develops within two years after primary infection with Coxiella burnetii. We determined the interval between acute Q fever and diagnosis of chronic infection, assessed what factors contribute to a longer interval, and evaluated the long-term follow-up. METHODS From 2007-2018, patients with chronic Q fever were included from 45 participating hospitals. The interval between acute and chronic infection was calculated in patients with a known day of first symptoms and/or serological confirmation of acute Q fever. Chronic Q fever-related complications and mortality were assessed by two investigators based on predefined criteria. RESULTS In total, 313 (60.3%) proven, 81 (15.6%) probable and 125 (24.1%) possible chronic Q fever patients were identified. The date of acute Q fever was known in 200 patients: in 45 (22.5%) the interval was longer than two years with the longest observed interval being 9.2 years. Patients in whom serological follow-up was performed after acute Q fever were diagnosed less often after this two-year interval (OR 0.26, 95% CI 0.12-0.54). Chronic Q fever-related complications occurred in 216 patients (41.6%). Chronic Q fever-related mortality occurred in 83 (26.5%) of proven and 3 (3.7%) of probable chronic Q fever patients. CONCLUSIONS Chronic Q fever is still being diagnosed and mortality keeps occurring eight years after a large outbreak. Intervals between acute Q fever and diagnosis of chronic infection can reach over 9 years. We urge physicians to perform microbiological testing for chronic Q fever even many years after an outbreak or acute Q fever disease.
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Affiliation(s)
- Sheila B Buijs
- Department of Internal Medicine and Infectious Diseases, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Chantal P Bleeker-Rovers
- Department of Internal Medicine and Infectious Diseases, Radboud Expertise Centre for Q Fever, Radboud university medical center, Nijmegen, the Netherlands
| | - Sonja E van Roeden
- Department of Internal Medicine and Infectious Diseases, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Linda M Kampschreur
- Department of Internal Medicine, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Andy I M Hoepelman
- Department of Internal Medicine and Infectious Diseases, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Peter C Wever
- Department of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | - Jan Jelrik Oosterheert
- Department of Internal Medicine and Infectious Diseases, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
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Stewart AG, Broom J, Sowden D, Hollett P. Acute kidney injury in acute Q fever. Intern Med J 2020; 49:1326-1329. [PMID: 31602773 DOI: 10.1111/imj.14447] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/11/2019] [Accepted: 03/11/2019] [Indexed: 11/30/2022]
Abstract
Coxiella burnetii infection is not known to involve directly the kidneys. Kidney injury associated with Q fever usually manifests in the setting of chronic infection or endocarditis with development of immune complex deposition. Acute kidney injury (AKI) in the context of acute Q fever infection may be more pathologically heterogeneous. We describe two cases of severe AKI secondary to acute Q fever infection, each with marked differences in pathological characteristics, and clinical course.
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Affiliation(s)
- Adam G Stewart
- Department of Infectious Diseases, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Jennifer Broom
- Department of Infectious Diseases, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - David Sowden
- Department of Infectious Diseases, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Peter Hollett
- Department of Renal Medicine, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
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Koo B, Jin CE, Bae M, Jang YO, Kim JY, Kim SH, Shin Y. Detection of Coxiella burnetii Using Silicon Microring Resonator in Patient Blood Plasma. Micromachines (Basel) 2019; 10:E427. [PMID: 31252533 DOI: 10.3390/mi10070427] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 06/21/2019] [Accepted: 06/25/2019] [Indexed: 11/16/2022]
Abstract
Blood plasma from patients is a powerful resource for diagnosing infectious disease due to it having many genetic materials as well as being relatively easy to obtain. Thus, various biosensors have been investigated for diagnosing diseases in blood plasma. However, there are no optimized and validated sensors for clinical use due to the low sensitivity, complexity, and difficulties of removing the inhibitors from plasma samples. In this study, we described a silicon microring resonator sensor used to detect Coxiella burnetii from the blood plasma of Q-fever patients in a label-free, real-time manner. Q-fever is an infectious disease caused by Coxiella burnetii via direct contact or inhalation aerosols. We validated this biosensor in the blood plasma of 35 clinical samples (including 16 Q fever samples infected with Coxiella burnetii and 19 samples infected with other febrile diseases. The biosensors are capable of rapid (10 min), highly sensitive (87.5%), and specific (89.5%) detection in plasma samples compared to the use of the conventional method.
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Keijmel SP, Krijger E, Delsing CE, Sprong T, Nabuurs-Franssen MH, Bleeker-Rovers CP. Differentiation of Acute Q Fever from Other Infections in Patients Presenting to Hospitals, the Netherlands. Emerg Infect Dis 2016. [PMID: 26196955 PMCID: PMC4517711 DOI: 10.3201/eid2108.140196] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Differentiating acute Q fever from infections caused by other pathogens is essential. We conducted a retrospective case-control study to evaluate differences in clinical signs, symptoms, and outcomes for 82 patients with acute Q fever and 52 control patients who had pneumonia, fever and lower respiratory tract symptoms, or fever and hepatitis, but had negative serologic results for Q fever. Patients with acute Q fever were younger and had higher C-reactive protein levels but lower leukocyte counts. However, a large overlap was found. In patients with an indication for prophylaxis, chronic Q fever did not develop after patients received prophylaxis but did develop in 50% of patients who did not receive prophylaxis. Differentiating acute Q fever from other respiratory infections, fever, or hepatitis is not possible without serologic testing or PCR. If risk factors for chronic Q fever are present, prophylactic treatment is advised.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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