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1.
Tidsskr Nor Laegeforen ; 139(12)2019 09 10.
Artigo em Norueguês | MEDLINE | ID: mdl-31502778

RESUMO

BACKGROUND: This case report presents one of the first documented incidents of chronic Q-fever (C. burnetii) in Norway. A comprehensive workup resulted in an unexpected finding. CASE PRESENTATION: A Norwegian woman in her eighties presented to a district general hospital with lower back pain, decreased general condition and weight loss. Computer tomography (CT) revealed a large thoracic aortic aneurysm presumed to be of mycotic origin, and later magnetic resonance imaging (MRI) scans revealed osteomyelitis in the surrounding vertebrae. Conventional diagnostic workup did not identify the causative agent. After more than 6 months of different examinations, surgery, exhausting invasive procedures and antimicrobial treatment, we were ultimately successful in determining the microbial cause of chronic mycotic aneurism and osteomyelitis to be C. Burnetii (Q-fever) through serological and PCR analysis. INTERPRETATION: An increasing proportion of the population in all age groups travel abroad, and clinicians should be aware of the increasing incidence of imported infectious diseases. Obtaining a thorough medical history is still an important tool in the diagnostic process.


Assuntos
Aneurisma da Aorta Torácica/microbiologia , Osteomielite/microbiologia , Febre Q , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Aneurisma da Aorta Torácica/diagnóstico por imagem , Coxiella burnetii/isolamento & purificação , Feminino , Humanos , Dor Lombar/microbiologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/microbiologia , Imagem por Ressonância Magnética , Anamnese , Noruega , Osteomielite/diagnóstico por imagem , Febre Q/complicações , Febre Q/diagnóstico , Febre Q/tratamento farmacológico , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/microbiologia , Tomografia Computadorizada por Raios X , Doença Relacionada a Viagens , Perda de Peso
3.
Int J Infect Dis ; 88: 21-26, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31382048

RESUMO

BACKGROUND: Q fever endocarditis (QFE) is considered rare in the Middle East, with only a few cases reported in Saudi Arabia. The aim of this study is to report on the experience of our centre on QFE. METHODS: We searched the medical records for cases of QFE at our cardiac center from 2009-2018. Demographic data, clinical features, serology and echocardiography results, treatments, and outcomes were assessed. RESULTS: Five hundred and two cases of infective endocarditis were detected over the 10 years period. Among the 234 patients with blood culture-negative endocarditis (BCNE), 19 (8.10%) had QFE. All patients had a previously diagnosed congenital heart disease except for one patient with rheumatic heart disease. Eleven patients had received a bovine jugular vein-related implant, e.g., a Melody valve (seven patients) or Contegra conduit (four patients). Coinfection was detected in three patients, and immunologic and embolic phenomena were observed in five patients. All patients received a combination of hydroxychloroquine and doxycycline, with good outcomes. Only two patients required surgery while on treatment. Two patients died several months after treatment; the cause of death was not identified. CONCLUSION: This study indicates that Q fever exists in our population. The majority of the patients had congenital heart disease (CHD) and underwent bovine jugular vein implants. Patients with CHD are at increased risk of infective endocarditis. Bovine jugular vein implants increase the risk of infective and possibly QFE. Proper exclusion of Q fever is warranted in all BCNE and possibly in culture-positive endocarditis cases in areas endemic to Q fever. KEY POINTS: We presented the largest series of Q fever endocarditis cases in Saudi Arabia. We showed that Q fever is not rare in the Middle East and suggest that it should be considered in all blood culture-negative endocarditis cases.


Assuntos
Antibacterianos/uso terapêutico , Endocardite Bacteriana/diagnóstico , Cardiopatias/cirurgia , Febre Q/complicações , Adolescente , Adulto , Criança , Doxiciclina/uso terapêutico , Endocardite Bacteriana/epidemiologia , Endocardite Bacteriana/etiologia , Endocardite Bacteriana/microbiologia , Feminino , Cardiopatias/congênito , Humanos , Hidroxicloroquina/uso terapêutico , Veias Jugulares/cirurgia , Masculino , Registros Médicos , Pessoa de Meia-Idade , Febre Q/diagnóstico , Febre Q/epidemiologia , Febre Q/microbiologia , Estudos Retrospectivos , Fatores de Risco , Arábia Saudita/epidemiologia , Centros de Atenção Terciária , Adulto Jovem
4.
J Vet Diagn Invest ; 31(4): 634-639, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31179891

RESUMO

A cluster of 4 bovine abortions caused by Coxiella burnetii occurred in a dairy herd in Uruguay during a 2-mo period. Case 1 consisted of a placenta from an aborted cow; cases 2-4 were fetuses and their placentas. Grossly, the placenta from one aborted cow had moderate, diffuse reddening of the cotyledons and loss of translucency of the intercotyledonary areas. No gross lesions were observed in the other 3 placentas. Microscopically, 2 of 4 placentas had fibrinonecrotizing placentitis with abundant intratrophoblastic gram-negative coccobacilli. C. burnetii was identified intralesionally by immunohistochemistry (IHC) in all 4 placentas, and by PCR and DNA sequencing in 3 placentas analyzed by these techniques. One fetus had mild neutrophilic alveolitis with multinucleate syncytial cells; no gross or microscopic lesions were observed in the other 2 fetuses examined. The lungs of the 3 fetuses were negative for C. burnetii by IHC. Tests performed to investigate other possible causes of abortions in the 4 cases were negative. C. burnetii causes Q fever in humans and coxiellosis in animals. Clusters of abortions in cattle by C. burnetii have not been reported previously, to our knowledge; this bacterium has been considered an opportunistic pathogen associated only with sporadic abortion in cattle. We present herein a cluster of 4 bovine abortions caused by C. burnetii in a dairy farm during a period of 2 mo and a review of the literature on C. burnetii infection in cattle.


Assuntos
Aborto Animal/microbiologia , Doenças dos Bovinos/microbiologia , Coxiella burnetii/isolamento & purificação , Complicações Infecciosas na Gravidez/veterinária , Febre Q/veterinária , Aborto Animal/epidemiologia , Animais , Bovinos , Coxiella burnetii/genética , Feminino , Feto/microbiologia , Feto/patologia , Humanos , Imuno-Histoquímica , Placenta/microbiologia , Placenta/patologia , Reação em Cadeia da Polimerase/veterinária , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/microbiologia , Febre Q/complicações , Febre Q/epidemiologia , Febre Q/microbiologia , Uruguai/epidemiologia
5.
Rev Bras Parasitol Vet ; 28(2): 245-257, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31215610

RESUMO

This is a cross-sectional study to assess the presence of antibodies in ruminants against selected pathogens associated with reproductive disorders in cattle in four Brazilian states, including the zoonotic agent Coxiella burnetii. The used tests were Virus Neutralization Assay for IBR and BVD, Microscopic Agglutination Test for Leptospira spp., Indirect Fluorescent Antibody Test (IFAT) for C. burnetii and Toxoplasma gondii, and Enzyme-Linked Immunosorbent Assay for Neospora caninum and Trypanosoma vivax. Seropositivity for C. burnetii was 13.7% with titers from 128 to 131,072; 57.8% for BoHV-1, with titers between 2 and 1,024; 47.1% for BVDV-1a, with titers from 10 to 5,120; 89.2% for N. caninum; 50% for T. vivax; and 52.0% for Leptospira spp., with titers between 100 to 800 (the following serovars were found: Tarassovi, Grippotyphosa, Canicola, Copenhageni, Wolffi, Hardjo, Pomona and Icterohaemorrhagiae); 19.6% for T. gondii with titer of 40. This is the first study that has identified C. burnetii in cattle associated with BoHV and BVDV, N. caninum, Leptospira spp., T. gondii and T. vivax. Thus, future studies should be conducted to investigate how widespread this pathogen is in Brazilian cattle herds.


Assuntos
Doença das Mucosas por Vírus da Diarreia Viral Bovina/complicações , Doenças dos Bovinos/epidemiologia , Coccidiose/veterinária , Leptospirose/veterinária , Febre Q/veterinária , Toxoplasmose Animal/complicações , Tripanossomíase Africana/veterinária , Aborto Animal , Testes de Aglutinação , Animais , Doença das Mucosas por Vírus da Diarreia Viral Bovina/diagnóstico , Doença das Mucosas por Vírus da Diarreia Viral Bovina/epidemiologia , Brasil/epidemiologia , Bovinos , Doenças dos Bovinos/microbiologia , Doenças dos Bovinos/parasitologia , Doenças dos Bovinos/virologia , Coccidiose/complicações , Coccidiose/diagnóstico , Coccidiose/epidemiologia , Coxiella burnetii/imunologia , Estudos Transversais , Vírus da Diarreia Viral Bovina/imunologia , Endometrite/etiologia , Ensaio de Imunoadsorção Enzimática/veterinária , Feminino , Técnica Indireta de Fluorescência para Anticorpo/veterinária , Infertilidade Feminina/etiologia , Leptospira/imunologia , Leptospirose/complicações , Leptospirose/diagnóstico , Leptospirose/epidemiologia , Neospora/imunologia , Febre Q/complicações , Febre Q/diagnóstico , Febre Q/epidemiologia , Estudos Soroepidemiológicos , Toxoplasma/imunologia , Toxoplasmose Animal/diagnóstico , Trypanosoma vivax/imunologia , Tripanossomíase Africana/complicações , Tripanossomíase Africana/diagnóstico , Tripanossomíase Africana/epidemiologia
7.
Eur J Clin Invest ; 49(7): e13123, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31077590

RESUMO

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.


Assuntos
Febre Q/complicações , Escleroderma Sistêmico/complicações , Idoso , Anticorpos Antibacterianos/metabolismo , Doença Crônica , Coxiella burnetii/imunologia , Feminino , Humanos , Imunoglobulina G/metabolismo , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Escleroderma Sistêmico/tratamento farmacológico
8.
Br J Radiol ; 92(1095): 20180292, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30608178

RESUMO

METHODS:: We analyzed high-resolution CT (HRCT) findings from six male patients (mean age, 22.6 years) with confirmed diagnoses of acute Q fever. Two chest radiologists analyzed the images and reached decisions by consensus. All patients presented fever, myalgia, prostation, headache, and dry cough. They also had common epidemiologic factors (recent travel for military service, where they had contact with sheep and capybara). Diagnoses were confirmed by the detection of C. burnetii DNA in clinical samples by polymerase chain reaction. RESULTS:: The predominant HRCT findings were areas of consolidation (100%) and nodules (66.6%) with halos of ground-glass opacity, predominantly with segmental and peripheral distributions. Lesions affected all lobes, and predominated in the left upper and lower lobes. Involvement of more than one lobe was observed in four patients. No pleural effusion or lymph node enlargement was found. CONCLUSION:: The predominant HRCT findings in patients with acute Q fever pneumonia were bilateral, peripheral areas of consolidation and nodules with irregular contours and halos of ground-glass opacity. ADVANCES IN KNOWLEDGE:: Acute Q fever should be included in the differential diagnosis of lesions with the halo sign on HRCT.


Assuntos
Pulmão/diagnóstico por imagem , Pneumonia Bacteriana/diagnóstico por imagem , Febre Q/complicações , Tomografia Computadorizada por Raios X/métodos , Adulto , Coxiella burnetii/genética , Humanos , Pulmão/patologia , Masculino , Febre Q/diagnóstico por imagem , Estudos Retrospectivos
9.
Immunobiology ; 224(2): 254-261, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30638649

RESUMO

PURPOSE: Coxiella burnetii has been suggested as a potential cause of B-cell non-Hodgkin lymphoma (B-NHL), as C. burnetii was detected in B-NHL tissues. To further investigate this potential relationship, we hypothesized that among subjects previously exposed to C. burnetii, the bacterium is more frequently detectable in tissues of patients with B-NHL (cases) compared to patients without B-NHL (controls). METHODS: We aimed to evaluate this hypothesis by assessing the presence of C. burnetii with polymerase chain reaction (PCR), immunofluorescence staining (IF) and fluorescent in-situ hybridization (FISH). Eligible patients were those previously exposed to C. burnetii. RESULTS: Samples were available for 13 cases and 16 controls. C. burnetii was demonstrated in tissues of 8/29 patients in total (28%), with either PCR, IF or FISH: in 5/13 cases (38%) and 3/16 controls (19%), p = 0.41. Negative and positive control samples were all negative and positive appropriately for all three diagnostic methods. CONCLUSIONS: In patients previously exposed to C. burnetii the bacterium was detected in tissue samples from subjects with and without B-NHL, without significant differences in the proportion positive samples. Therefore, we conclude that detection of C. burnetii in tissues of patients previously exposed to C. burnetii is a non-specific finding.


Assuntos
Coxiella burnetii , Linfoma não Hodgkin/etiologia , Febre Q/complicações , Febre Q/microbiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Coxiella burnetii/genética , Suscetibilidade a Doenças , Feminino , Imunofluorescência , Humanos , Hibridização in Situ Fluorescente , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase
10.
Trop Anim Health Prod ; 51(4): 983-986, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30456693

RESUMO

Abortion is a major cause of economic loss to the goat industry. Coxiella burnetii the causative agent of Q fever is an important zoonotic agent known to be prevalent worldwide. In the present investigation, we detected the presence of Coxiella burnetii by the modified Ziehl Neelsen method of staining and its DNA by trans-PCR assay in the placenta obtained from the aborted goat. We also ruled out other common causes of abortion in this case. Based on a literature survey, this is the first report on the direct detection of Coxiella burnetii from an aborted goat to be reported from India.


Assuntos
Aborto Animal/microbiologia , Coxiella burnetii/isolamento & purificação , Doenças das Cabras/microbiologia , Febre Q/microbiologia , Animais , Coxiella burnetii/genética , DNA Bacteriano/análise , Feminino , Cabras , Índia , Reação em Cadeia da Polimerase/veterinária , Febre Q/complicações
11.
J Microbiol Immunol Infect ; 52(1): 54-61, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28709838

RESUMO

BACKGROUND/PURPOSE: The clinical manifestations of scrub typhus, murine typhus and acute Q fever in the elderly are not clear. METHODS: We conducted a retrospective study to identify the characteristics of the elderly aged ≥65 years with a comparison group aged 18-64 years among patients with scrub typhus, murine typhus, or acute Q fever who were serologically confirmed at three hospitals in Taiwan during 2002-2011. RESULTS: Among 441 cases, including 187 cases of scrub typhus, 166 acute Q fever, and 88 murine typhus, 68 (15.4%) cases were elderly patients. The elderly had a higher severe complication rate (10.3% vs. 3.5%, p = 0.022), but did not have a significantly higher mortality rate (1.47% vs. 0.54%, p = 0.396). Compared with those without severe complications, we found the elderly (p = 0.022), dyspnea (p = 0.006), less relative bradycardia (p = 0.004), less febrile illness (p = 0.004), prolonged prothrombin time (PT) (p = 0.002), higher levels of initial C-reactive protein (p = 0.039), blood leukocyte counts (p = 0.01), and lower platelet counts (p = 0.012) are significantly associated with severe complications. Only prolonged prothrombin time was associated with severe complications in multivariate analysis (p = 0.018, CI 95% 0.01-0.66). Among clinical symptoms and laboratory data, multivariate analysis revealed chills was less frequently occurred in the elderly (p = 0.012, 95% confidence interval [CI]: 1.33-9.99). CONCLUSION: The elderly cases with scrub typhus, murine typhus, or acute Q fever would be more likely to have severe complications, for which prothrombin time prolongation is an important predictor for severe complications.


Assuntos
Tempo de Protrombina/normas , Febre Q/complicações , Tifo por Ácaros/complicações , Índice de Gravidade de Doença , Tifo Endêmico Transmitido por Pulgas/complicações , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Febre Q/fisiopatologia , Estudos Retrospectivos , Tifo por Ácaros/fisiopatologia , Taiwan , Tifo Endêmico Transmitido por Pulgas/fisiopatologia
12.
Saudi Med J ; 39(12): 1195-1199, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30520500

RESUMO

OBJECTIVES: To evaluate the presence of Coxiella burnetii  (C. brunetii) infection among patients presenting with fever of unknown origin (FUO). METHODS: A cross-sectional study of 100 patients (54 men and 46 women; mean age: 34.3 ± 19.2 years) with FUO was conducted at King Khalid University Hospital, Riyadh, Saudi Arabia between March 2015 and June 2016. Phase 1 and phase 2 C. burnetii-specific antibodies in serum samples were detected by enzyme-linked immunosorbent assay. RESULTS: Coxiella burnetii phase 1 and phase 2 antibodies were detected in 16% of the patients. Phase 2 IgM was present in 2% of the patients, whereas phase 2 IgG antibodies were detected in 11%  of the patients. Coxiella burnetii-specific phase 1 IgG was found in 2% of the patients, and 8% of the patients harbored phase 1 IgA antibodies in their serum. CONCLUSION: The presence of C. burnetii-specific antibodies in many patients suffering from FUO highlights the importance of Q fever screening among patients presenting with febrile illness.


Assuntos
Febre de Causa Desconhecida/etiologia , Febre Q/diagnóstico , Adolescente , Adulto , Anticorpos Antibacterianos/imunologia , Coxiella burnetii/imunologia , Estudos Transversais , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Imunoglobulina A/imunologia , Imunoglobulina G/imunologia , Imunoglobulina M/imunologia , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Febre Q/complicações , Arábia Saudita , Testes Sorológicos , Adulto Jovem
13.
Microb Pathog ; 125: 272-275, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30243553

RESUMO

Q fever is a worldwide zoonotic disease, caused by Coxiella burnetii (C. burnetii), an obligate intracellular bacterium. The epidemiological data about the Q fever situation in Egypt is limited. The present study investigated the seroprevalence of Q fever among small ruminants in some localities in the northern Egypt and reported the shedders using specific real-time PCR (Rt-PCR). A total of 190 sera and vaginal swabs (110 sheep and 80 goats) were collected from aborted cases. Indirect ELISA was used to detect specific antibodies against C. burnetii, and Rt-PCR was used to detect DNA in the shedder animals. The study revealed that infection was significantly higher in sheep (22.7%) than in goats (12.5%) (p < 0.05). The Menoufia and Gharbia governorates had 20% seropositive animals while Qalubia and Alexandria had 15% and 17.5% seropositive animals, respectively. Using a Rt - PCR assay, C. burnetii was detected in 33.6% and 16.3% of sheep and goats, respectively. The findings of the study demonstrate that Q fever may be enzootic among small ruminants and distributed in the northern Egyptian Governorates. Further studies are needed in different regions to gain better understanding of the epidemiology of Q fever all over the country and to develop an appropriate preventive strategy for human and animals.


Assuntos
Aborto Séptico/veterinária , Anticorpos Antibacterianos/sangue , Coxiella burnetii/imunologia , Coxiella burnetii/isolamento & purificação , Doenças das Cabras/epidemiologia , Febre Q/veterinária , Doenças dos Ovinos/epidemiologia , Aborto Séptico/epidemiologia , Animais , Derrame de Bactérias , Coxiella burnetii/genética , Egito/epidemiologia , Feminino , Cabras , Gravidez , Febre Q/complicações , Febre Q/epidemiologia , Reação em Cadeia da Polimerase em Tempo Real , Estudos Soroepidemiológicos , Ovinos , Vagina/microbiologia
14.
Appl Environ Microbiol ; 84(20)2018 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-30076194

RESUMO

This study describes a Q fever outbreak in a herd of 77 Alpine goats which suffered a high rate of abortions (81% [58/72]) in January 2017 and presents the results of monitoring the contamination and viability of Coxiella burnetii in the farm environment several months after the outbreak. Over the course of 7 months, we studied bacterial shedding by 35 dams with abortions to monitor C. burnetii infection dynamics and the duration of excretion. The highest bacterial shedding load was observed in vaginal mucus, followed by in feces and in milk. Conversely, the duration of C. burnetii shedding was longer through feces (5 months after abortion) than milk (3 months). C. burnetii DNA was detected throughout the study in aerosol samples periodically collected indoors and outdoors from the animal premises. Mouse inoculation and culture in Vero cells demonstrated the presence of viable isolates in dust collected from different surfaces inside the animal facilities during the period of time with the highest number of abortions but not in dust collected 2, 3, and 4 months after the last parturition. Some workers and visitors were affected by Q fever, with attack rates of 78% (7/9) and 31% (4/13), respectively. Affected people mostly showed fever and seroconversion, along with myalgia and arthralgia in two patients and pneumonia in the index case. The genotype identified in animal and environmental samples (SNP1/MST13) turned out to be very aggressive in goats but caused only moderate symptoms in people. After the diagnosis of abortion by Q fever in goats, several control measures were implemented at the farm to prevent contamination inside and outside the animal facilities.IMPORTANCE This work describes a 7-month follow-up of the excretion by different routes of Coxiella burnetii genotype SNP1/MST13 in a herd of goats that suffered high rate of abortions (81%), generating high environmental contamination. Some of the workers and visitors who accessed the farm were infected, with fever as the main symptom but a low incidence of pneumonia. The detected strain (SNP1/MST13 genotype) turned out to be very aggressive in goats. The viability of C. burnetii was demonstrated in the environment of the farm at the time of abortions, but 2 months after the last parturition, no viable bacteria were detected. These results highlighted the importance of implementing good biosafety measures at farms and avoiding the entrance of visitors to farms several months after the end of the kidding period.


Assuntos
Aborto Animal/microbiologia , Derrame de Bactérias , Surtos de Doenças/veterinária , Doenças das Cabras/microbiologia , Viabilidade Microbiana , Febre Q/veterinária , Animais , Coxiella burnetii/genética , Coxiella burnetii/isolamento & purificação , DNA Bacteriano/genética , DNA Bacteriano/isolamento & purificação , Microbiologia Ambiental , Fazendeiros , Fazendas , Fezes/microbiologia , Feminino , Cabras , Humanos , Camundongos , Gravidez , Febre Q/complicações , Febre Q/epidemiologia , Células Vero
15.
Medicine (Baltimore) ; 97(34): e11881, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30142785

RESUMO

Coxiella burnetii is a common cause of blood culture-negative infective endocarditis (IE). Molecular detection of C burnetii DNA in clinical specimens is a promising method of diagnosing Q fever endocarditis. Here, we examined the diagnostic utility of Q fever polymerase chain reaction (PCR) of formalin-fixed heart valve tissue from patients with blood culture-negative IE who underwent heart valve surgery. Clinical and laboratory data of patients with blood culture-negative IE who underwent heart valve surgery during a 6-year period and for whom biopsy tissues were available were reviewed retrospectively. Blood culture-positive IE patients who underwent heart valve surgery within the last 3 years were used as controls. Heart valve samples were cultured and also subjected to histological examination and PCR for Q fever, brucellosis, and bartonellosis. Data from 20 patients with blood culture-negative IE and 20 with blood culture-positive IE were analyzed. Eight cases of blood culture-negative IE were PCR-positive for C burnetii (40%; 95% confidence interval, 19-64). No specimen was PCR-positive for brucellosis or bartonellosis. Histologically, 4 of 8 specimens with a positive Q fever PCR result were characterized by clusters of multinucleated giant cells without a fibrin ring. None of 20 patients with blood culture-negative IE received anti-Coxiella antibiotic therapy due to lack of clinical suspicion. Six-month mortality was higher in the Q fever PCR-positive group than in the Q fever PCR-negative group [38% (3/8) vs 0% (0/12), P = .049). Of the 20 patients with blood culture-positive IE, none yielded a positive Q fever PCR result for valve tissue. Approximately 40% of patients with culture-negative IE who received heart valve surgery were PCR-positive for Q fever; patients without clinical suspicion suffered high mortality. These data suggest that Q fever IE in patients with culture-negative IE is often missed in routine clinical practice.


Assuntos
Coxiella burnetii/genética , Endocardite/microbiologia , Valvas Cardíacas/microbiologia , Reação em Cadeia da Polimerase/métodos , Febre Q/diagnóstico , Adulto , Idoso , Hemocultura , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Endocardite/diagnóstico , Endocardite/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Febre Q/complicações , Estudos Retrospectivos , Taxa de Sobrevida
17.
Eur J Intern Med ; 54: 6-12, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29908707

RESUMO

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.


Assuntos
Autoimunidade , Linfócitos B/imunologia , Febre Q/imunologia , Anticorpos/sangue , Coxiella burnetii , Crioglobulinemia/complicações , Crioglobulinemia/microbiologia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/epidemiologia , Humanos , Febre Q/complicações
18.
Lancet Haematol ; 5(5): e211-e219, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29650493

RESUMO

BACKGROUND: An association between Coxiella burnetii and non-Hodgkin lymphoma has been suggested. After a large Q fever epidemic in the Netherlands (2007-10), we postulated that the incidence of non-Hodgkin lymphoma would be increased during and after the epidemic in areas with a high endemicity of Q fever compared with those with low endemicity. METHODS: We did a retrospective population-based analysis and calculated relative risks (RRs) of non-Hodgkin lymphoma during 1-year periods before, during, and after the Q fever epidemic, for areas with intermediate and high endemicity of Q fever compared with low endemic areas. We also calculated the RR of non-Hodgkin lymphoma in people with chronic Q fever compared with the general population. FINDINGS: Between Jan 1, 2002, and Dec 31, 2013, 48 760 cases of non-Hodgkin lymphoma were diagnosed. The incidence of non-Hodgkin lymphoma ranged from 21·4 per 100 000 per year in 2002 to 26·7 per 100 000 per year in 2010. A significant association with non-Hodgkin lymphoma was noted in 2009 for areas with a high endemicity of Q fever compared with low endemic areas (RR 1·16, 95% CI 1·02-1·33; p=0·029); no further associations were noted in any other year or for areas with intermediate Q fever endemicity. Among 439 individuals with chronic Q fever, five developed non-Hodgkin lymphoma, yielding a crude absolute risk of 301·0 cases per 100 000 per year (RR 4·99, 95% CI 2·07-11·98; p=0·0003) compared with the general population in the Netherlands. INTERPRETATION: These findings do not support the hypothesis that Q fever has a relevant causal role in the development of non-Hodgkin lymphoma. Several limitations, inherent to the design of this study, might lead to both underestimation and overestimation of the studied association. FUNDING: Foundation Q-support and Institut Mérieux.


Assuntos
Linfoma não Hodgkin/epidemiologia , Linfoma não Hodgkin/microbiologia , Febre Q/complicações , Febre Q/epidemiologia , Adulto , Idoso , Coxiella burnetii , Doenças Endêmicas , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Febre Q/microbiologia , Estudos Retrospectivos , Risco , Adulto Jovem
20.
PLoS Negl Trop Dis ; 12(3): e0006338, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29543806

RESUMO

BACKGROUND: Forms of presentation of Q fever vary widely across Spain, with differences between the north and south. In the absence of reported case series from Galicia (north-west Spain), this study sought to describe a Q-fever case series in this region for the first time, and conduct a systematic review to analyse all available data on the disease in Spain. METHODS: Patients with positive serum antibodies to Coxiella burnetii from a single institution over a 5-year period (January 2011-December 2015) were included. Patients with phase II titres above 1/128 (or documented seroconversion) and compatible clinical criterial were considered as having Q fever. Patients with clinical suspicion of chronic Q-fever and IgG antibodies to phase I-antigen of over 1/1024, or persistently high levels six months after treatment were considered to be cases of probable chronic Q-fever. Systematic review: We conducted a search of the Pubmed/Medline database using the terms: Q Fever OR Coxiella burnetii AND Spain. Our search yielded a total of 318 studies: 244 were excluded because they failed to match the main criteria, and 41 were discarded due to methodological problems, incomplete information or duplication. Finally, 33 studies were included. RESULTS: A total of 155 patients, all of them from Galicia, with positive serological determination were located during the study period; 116 (75%) were deemed to be serologically positive patients without Q fever and the remaining 39 (25%) were diagnosed with Q fever. A potential exposure risk was found in 2 patients (5%). The most frequent form of presentation was pneumonia (87%), followed by isolated fever (5%), diarrhoea (5%) and endocarditis (3%). The main symptoms were headache (100%), cough (77%) and fever (69%). A trend to a paucisymptomatic illness was observed in women. Hospital admission was required in 37 cases, and 6 patients died while in hospital. Only 2 patients developed chronic Q-fever. Systematic review: Most cases were sporadic, mainly presented during the winter and spring, as pneumonia in 37%, hepatitis in 31% and isolated fever in 29.6% of patients. In the north of Spain, 71% of patients had pneumonia, 13.2% isolated fever and 13% hepatitis. In the central and southern areas, isolated fever was the most frequent form of presentation (40%), followed by hepatitis (38.4%) and pneumonia (17.6%). Only 31.7% of patients reported risk factors, and an urban-environment was the most frequent place of origin. Overall mortality was 0.9%, and the percentage of patients with chronic forms of Q-fever was 2%. CONCLUSIONS: This is the first study to report on a Q-fever case series in Galicia. It shows that in this region, the disease affects the elderly population -even in the absence of risk factors- and is linked to a higher mortality than reported by previous studies. While pneumonia is the most frequent form of presentation in the north of the country, isolated fever and hepatitis tend to be more frequent in the central and southern areas. In Spain, 32% of Q-fever cases do not report contact with traditional risk factors, and around 58% live in urban areas.


Assuntos
Anticorpos Antibacterianos/sangue , Coxiella burnetii , Febre Q/diagnóstico , Febre Q/mortalidade , Estações do Ano , Febre/etiologia , Hepatite/epidemiologia , Humanos , Admissão do Paciente , Pneumonia/epidemiologia , Febre Q/complicações , Fatores de Risco , Espanha/epidemiologia
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