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1.
BMC Infect Dis ; 19(1): 903, 2019 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-31660875

RESUMO

BACKGROUND: Acute Q fever usually presents as a nonspecific febrile illness, and its occurrence is rapidly increasing in South Korea. This study investigated the clinical characteristics of acute Q fever patients in South Korea and the time from symptom onset to serologic diagnosis. The clinical courses were examined according to antibiotic treatment. METHODS: Data of patients diagnosed with acute Q fever at Chungbuk National University Hospital between January 2015 and February 2018 were retrospectively collected. Demographic and epidemiologic data were reviewed. The time from symptom onset to serologic diagnosis by an immunofluorescence assay (IFA) was analyzed. Clinical courses and the percentage of patients with a high phase I immunoglobulin G titer (≥ 1:1024) were compared between patients administered antibiotics with anti-Coxiella burnetii activity and patients not administered such antibiotics. RESULTS: Forty-eight patients (median age: 51.5 years) were included. Most were male (95.8%) and had no history of animal contact (91.7%). The median time from illness onset to serologic diagnosis was 21 days. Thirty-nine patients received antibiotics with anti-C. burnetii activity. The length of hospital stay and fever duration did not significantly differ between patients who received antibiotics with anti-C. burnetii activity (7 and 15 days) and those who did not (5 and 8 days) (P = 0.110 and P = 0.137, respectively). The percentage of patients with a high phase I immunoglobulin G titer (≥ 1:1024) did not significantly differ between patients who received antibiotics with anti-C. burnetii activity and those who did not (P = 0.340). CONCLUSIONS: Most acute Q fever patients had a nonspecific febrile illness with mild elevation of transaminases and no history of animal contact or occupational risk. The time from symptom onset to a positive IFA test was longer than the fever duration in most acute Q fever patients. Consequently, it may be difficult for clinicians to serologically diagnose acute Q fever. However, inappropriate antibiotic treatment was not associated with prolongation of symptoms or progression to chronic Q fever.


Assuntos
Diagnóstico Tardio , Febre Q/diagnóstico , Febre Q/epidemiologia , Testes Sorológicos , Animais , Antibacterianos/uso terapêutico , Anticorpos Antibacterianos/sangue , Coxiella burnetii/imunologia , Feminino , Imunofluorescência , Seguimentos , Hospitalização , Hospitais Universitários , Humanos , Imunoglobulina G/sangue , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Febre Q/tratamento farmacológico , República da Coreia/epidemiologia , Estudos Retrospectivos
2.
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
4.
Infect Immun ; 87(10)2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31331958

RESUMO

Infection with Coxiella burnetii, the causative agent of Q fever, can result in life-threatening persistent infection. Reactogenicity hinders worldwide implementation of the only licensed human Q fever vaccine. We previously demonstrated long-lived immunoreactivity in individuals with past symptomatic and asymptomatic Coxiella infection (convalescents) to promiscuous HLA class II C. burnetii epitopes, providing the basis for a novel T-cell targeted subunit vaccine. In this study, we investigated in a cohort of 22 individuals treated for persistent infection (chronic Q fever) whether they recognize the same set of epitopes or distinct epitopes that could be candidates for a therapeutic vaccine or aid in the diagnosis of persistent infection. In cultured enzyme-linked immunosorbent spot (ELISpot) assays, individuals with chronic Q fever showed strong class II epitope-specific responses that were largely overlapping with the peptide repertoire identified previously for convalescents. Five additional peptides were recognized more frequently by chronic subjects, but there was no combination of epitopes uniquely recognized by or nonreactive in subjects with chronic Q fever. Consistent with more recent/prolonged exposure, we found, however, stronger ex vivo responses by direct ELISpot to both whole-cell C. burnetii and individual peptides in chronic patients than in convalescents. In conclusion, we have validated and expanded a previously published set of candidate epitopes for a novel T-cell targeted subunit Q fever vaccine in treated patients with chronic Q fever and demonstrated that they successfully mounted a T-cell response comparable to that of convalescents. Finally, we demonstrated that individuals treated for chronic Q fever mount a broader ex vivo response to class II epitopes than convalescents, which could be explored for diagnostic purposes.


Assuntos
Anticorpos Antibacterianos/biossíntese , Antígenos de Bactérias/imunologia , Coxiella burnetii/imunologia , Epitopos de Linfócito T/imunologia , Febre Q/imunologia , Idoso , Antibacterianos/uso terapêutico , Antígenos de Bactérias/química , Antígenos de Bactérias/genética , Vacinas Bacterianas/química , Vacinas Bacterianas/imunologia , Doença Crônica , Convalescença , Coxiella burnetii/patogenicidade , ELISPOT , Epitopos de Linfócito T/química , Epitopos de Linfócito T/genética , Feminino , Expressão Gênica , Antígenos de Histocompatibilidade Classe I/genética , Antígenos de Histocompatibilidade Classe I/imunologia , Antígenos de Histocompatibilidade Classe II/genética , Antígenos de Histocompatibilidade Classe II/imunologia , Teste de Histocompatibilidade , Humanos , Interferon gama/genética , Interferon gama/imunologia , Masculino , Pessoa de Meia-Idade , Peptídeos/genética , Peptídeos/imunologia , Febre Q/tratamento farmacológico , Febre Q/genética , Febre Q/prevenção & controle , Linfócitos T/imunologia , Linfócitos T/microbiologia
5.
Am J Trop Med Hyg ; 101(1): 33-39, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31115296

RESUMO

Query fever (Q fever), caused by Coxiella burnetii, was first described in southern California in 1947. It was found to be endemic and enzoonotic to the region and associated with exposure to livestock. We describe a series of 20 patients diagnosed with Q fever at a Veterans Affairs hospital in southern California, with the aim of contributing toward the understanding of Q fever in this region. Demographics, laboratory data, diagnostic imaging, risk factors, and treatment regimens were collected via a retrospective chart review of patients diagnosed with Q fever at our institution between 2000 and 2016. Cases were categorized as acute or chronic and confirmed or probable. The majority presented with an acute febrile illness (90%). There was a delay in ordering diagnostic serology from the time of symptom onset (acute cases, average 31.9 days; chronic cases, average 63 days), and 15% progressed from acute to chronic infection. Of the chronic cases, 22.2% had endocarditis, 22.2% had endovascular infection, and 11.1% had both endocarditis and endovascular infection. The geographic distribution revealed that 20% resided in rural areas. Of the cases of Q fever that died, death attributed to Q fever was associated with an average diagnostic delay of 65.5 days. Acute Q fever is underreported in this region largely because of its often nonspecific clinical presentation.


Assuntos
Antibacterianos/uso terapêutico , Doxiciclina/uso terapêutico , Hidroxicloroquina/uso terapêutico , Febre Q/diagnóstico , Febre Q/epidemiologia , Rifampina/uso terapêutico , Adulto , Idoso , California/epidemiologia , Doença Crônica , Doxiciclina/administração & dosagem , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/microbiologia , Endocardite Bacteriana/patologia , Hospitais de Veteranos , Humanos , Hidroxicloroquina/administração & dosagem , Masculino , Pessoa de Meia-Idade , Febre Q/tratamento farmacológico , Febre Q/patologia , Estudos Retrospectivos , Rifampina/administração & dosagem
6.
Am J Trop Med Hyg ; 100(5): 1130-1133, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30915946

RESUMO

A 56-year-old female goat herder had scrub typhus that persisted after receiving doxycycline for 5 days. Her symptoms continued, prompting us to perform further examinations that revealed coinfection of Q fever and scrub typhus via molecular and serological testing. We also isolated Orientia tsutsugamushi using BALB/c mice and L929 cells.


Assuntos
Coinfecção/diagnóstico , Coinfecção/microbiologia , Doxiciclina/uso terapêutico , Febre Q/tratamento farmacológico , Tifo por Ácaros/diagnóstico , Animais , Coinfecção/sangue , Coxiella burnetii , Feminino , Humanos , Camundongos , Camundongos Endogâmicos BALB C , Pessoa de Meia-Idade , Orientia tsutsugamushi/isolamento & purificação , Febre Q/diagnóstico , Tifo por Ácaros/sangue , Baço/microbiologia , Esplenomegalia/microbiologia
9.
QJM ; 111(11): 791-797, 2018 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-30102400

RESUMO

Background: Chronic Q fever is accompanied by high mortality and morbidity, and requires prolonged antibiotic treatment. Little is known on long-term quality of life (LQOL) in chronic Q fever patients treated with antibiotics. Aim: To identify patient and treatment-related factors associated with impaired LQOL in chronic Q fever patients treated with antibiotics, and to assess patients' perception on treatment. Design: Cross-sectional study. Methods: LQOL was assessed with a validated questionnaire from the Nijmegen Clinical Screening Instrument. Patients' perception on treatment was measured with three newly developed questions. Results: We included 64 patients: LQOL was impaired in 55% (n = 35) after a median follow-up of 5 years. Median treatment duration was 27 months. In multivariable analysis, treatment duration was significantly associated with impaired LQOL (OR 1.07; 95%CI 1.02-1.12, P < 0.01 per month increase). Age, gender, number of antibiotic regimens, surgical intervention, complications, diagnostic classification, focus of infection or registration of side effects during treatment were not associated with impaired LQOL. After start of treatment, 17 patients (27%) perceived improvement of their condition. Disadvantages of treatment were experienced on a daily basis by 24 patients (69%) with impaired LQOL and 13 patients (46%) without impaired LQOL (P = 0.04). Conclusions: LQOL in chronic Q fever patients treated with antibiotics is impaired in more than half of patients 5 years after diagnosis. Antibiotic treatment duration was the only variable associated with impaired LQOL. The majority of patients experienced disadvantages on a daily basis, highlighting the high burden of disease and treatment.


Assuntos
Antibacterianos/uso terapêutico , Febre Q/diagnóstico , Febre Q/tratamento farmacológico , Qualidade de Vida , Idoso , Antibacterianos/efeitos adversos , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Países Baixos , Inquéritos e Questionários , Fatores de Tempo
11.
J Antimicrob Chemother ; 73(4): 1068-1076, 2018 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-29325142

RESUMO

Background: First choice treatment for chronic Q fever is doxycycline plus hydroxychloroquine. Serum doxycycline concentration (SDC) >5 µg/mL has been associated with a favourable serological response, but the effect on clinical outcomes is unknown. Objectives: To assess the effect of measuring SDC during treatment of chronic Q fever on clinical outcomes. Methods: We performed a retrospective cohort study, to assess the effect of measuring SDC on clinical outcomes in patients treated with doxycycline and hydroxychloroquine for chronic Q fever. Primary outcome was the first disease-related event (new complication or chronic Q fever-related mortality); secondary outcomes were all-cause mortality and PCR-positivity. Multivariable analysis was performed with a Cox proportional hazards model, with shared-frailty terms for different hospitals included. Results: We included 201 patients (mean age 68 years, 83% male): in 167 patients (83%) SDC was measured, 34 patients (17%) were treated without SDC measurement. First SDC was >5 µg/mL in 106 patients (63%), all with 200 mg doxycycline daily. In patients with SDC measured, dosage was adjusted in 41% (n = 68), concerning an increase in 64 patients. Mean SDC was 4.1 µg/mL before dosage increase, and 5.9 µg/mL afterwards. SDC measurement was associated with a lower risk for disease-related events (HR 0.51, 95% CI 0.26-0.97, P = 0.04), but not with all-cause mortality or PCR-positivity. Conclusions: SDC measurement decreases the risk for disease-related events, potentially through more optimal dosing or improved compliance. We recommend measurement of SDC and striving for SDC >5 µg/mL and <10 µg/mL during treatment of chronic Q fever.


Assuntos
Antibacterianos/sangue , Doxiciclina/sangue , Monitoramento de Medicamentos , Febre Q/tratamento farmacológico , Soro/química , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Doxiciclina/administração & dosagem , Feminino , Humanos , Hidroxicloroquina/administração & dosagem , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento
12.
Pediatr Infect Dis J ; 37(3): 212-217, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-28938256

RESUMO

BACKGROUND: Q fever is a zoonosis caused by the bacterium Coxiella burnetii (C. burnetii) with a worldwide distribution. Our aim was to assess the epidemiology, clinical manifestations and treatment regimens of chronic Q fever infections in Israeli children during the past 25 years. METHODS: Cases were collected from the national Q fever reference laboratory database. Demographic, epidemiologic and clinical data were reviewed using a structured questionnaire sent to the referring physician. Cases were defined according to the new Dutch Consensus Guidelines. RESULTS: A total of 16 children originating from all regions of the country were found positive for chronic Q fever infections. The most common infection site was bone or joint (8/16, 50%), all in previously healthy children. Endovascular infections were found in 5 children (31%), all with an antecedent cardiac graft insertion. According to the new Consensus Guidelines, 9 children (56%) had a proven infection, 3 (19%) a probable infection and 4 (25%) a possible chronic Q fever infection. Almost all cases were treated with a long-term antibiotic regimen, often necessitating a change in medication because of persistent or rising titers. CONCLUSIONS: Although pediatric chronic Q fever infections are rare, incidence has been rising. The most common infection site was bone or joint. A high index of suspicion is necessary, even in cases of previously healthy children without a possible exposure history. Use of the relatively new diagnostic tools in combination with serologic methods is helpful in diagnosing proven cases. There is no consensus as to the selection or duration of antibiotic treatment.


Assuntos
Febre Q/epidemiologia , Adolescente , Antibacterianos/uso terapêutico , Biópsia , Criança , Pré-Escolar , Doença Crônica , Coxiella burnetii/genética , Coxiella burnetii/imunologia , Feminino , Hospitalização , Humanos , Israel/epidemiologia , Masculino , Reação em Cadeia da Polimerase , Vigilância da População , Febre Q/diagnóstico , Febre Q/tratamento farmacológico , Febre Q/microbiologia , Testes Sorológicos , Resultado do Tratamento
13.
Infection ; 46(1): 127-129, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28819912

RESUMO

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.


Assuntos
Antibacterianos/uso terapêutico , Coxiella burnetii/isolamento & purificação , Doxiciclina/uso terapêutico , Eritema Nodoso/diagnóstico , Febre Q/diagnóstico , Adulto , Eritema Nodoso/tratamento farmacológico , Eritema Nodoso/microbiologia , Feminino , Humanos , Febre Q/complicações , Febre Q/tratamento farmacológico , Resultado do Tratamento
14.
Clin Infect Dis ; 66(5): 719-726, 2018 02 10.
Artigo em Inglês | MEDLINE | ID: mdl-29040457

RESUMO

Background: Evidence on the effectiveness of first-line treatment for chronic Q fever, tetracyclines (TET) plus hydroxychloroquine (HCQ), and potential alternatives is scarce. Methods: We performed a retrospective, observational cohort study to assess efficacy of treatment with TET plus quinolones (QNL), TET plus QNL plus HCQ, QNL monotherapy, or TET monotherapy compared to TET plus HCQ in chronic Q fever patients. We used a time-dependent Cox proportional hazards model to assess our primary (all-cause mortality) and secondary outcomes (first disease-related event and therapy failure). Results: We assessed 322 chronic Q fever patients; 276 (86%) received antibiotics. Compared to TET plus HCQ (n = 254; 92%), treatment with TET plus QNL (n = 49; 17%), TET plus QNL plus HCQ (n = 29, 10%), QNL monotherapy (n = 93; 34%), or TET monotherapy (n = 54; 20%) were not associated with primary or secondary outcomes. QNL and TET monotherapies were frequently discontinued due to insufficient clinical response (n = 27, 29% and n = 32, 59%). TET plus HCQ, TET plus QNL, and TET plus QNL plus HCQ were most frequently discontinued due to side effects (n = 110, 43%; n = 13, 27%; and n = 12, 41%). Conclusions: Treatment of chronic Q fever with TET plus QNL appears to be a safe alternative for TET plus HCQ, for example, if TET plus HCQ cannot be tolerated due to side effects. Treatment with TET plus QNL plus HCQ was not superior to treatment with TET plus HCQ, although this may be caused by confounding by indication. Treatment with TET or QNL monotherapy should be avoided; switches due to subjective, insufficient clinical response were frequently observed.


Assuntos
Antibacterianos/uso terapêutico , Febre Q/tratamento farmacológico , Febre Q/mortalidade , Idoso , Antibacterianos/efeitos adversos , Doença Crônica/tratamento farmacológico , Coxiella burnetii , Quimioterapia Combinada , Feminino , Humanos , Hidroxicloroquina/efeitos adversos , Hidroxicloroquina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Modelos de Riscos Proporcionais , Quinolonas/efeitos adversos , Quinolonas/uso terapêutico , Estudos Retrospectivos , Tetraciclinas/efeitos adversos , Tetraciclinas/uso terapêutico , Falha de Tratamento
16.
Pediatr Cardiol ; 39(1): 195-197, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28948320

RESUMO

In this article we report the first case of Q fever endocarditis in a 13 years old child with a percutaneous pulmonary Melody® valve. The patient had a new onset of Melody valve dysfunction associated with the combination of hepatosplenomegaly and pancytopenia but was afebrile. Although blood cultures were negative, we have further investigated in the direction of infective endocarditis by performing PCR detection and the serology of C. burnetii which were positive. A combination antibiotic therapy with doxycycline and hydroxychloroquine was started with good clinical evolution. Our case emphasizes the fact that any Melody valvular dysfuntion should be considered as a potential infective endocarditis despite the absence of typical bacterial features.


Assuntos
Antibacterianos/uso terapêutico , Endocardite Bacteriana/diagnóstico , Infecções Relacionadas à Prótese/diagnóstico , Febre Q/diagnóstico , Adolescente , Coxiella burnetii/genética , Ecocardiografia/métodos , Endocardite Bacteriana/complicações , Endocardite Bacteriana/tratamento farmacológico , Próteses Valvulares Cardíacas/efeitos adversos , Humanos , Masculino , Infecções Relacionadas à Prótese/complicações , Infecções Relacionadas à Prótese/tratamento farmacológico , Valva Pulmonar/microbiologia , Valva Pulmonar/cirurgia , Febre Q/complicações , Febre Q/tratamento farmacológico
17.
Curr Protoc Microbiol ; 47: 6C.3.1-6C.3.11, 2017 11 09.
Artigo em Inglês | MEDLINE | ID: mdl-29120485

RESUMO

Coxiella burnetii is the causative agent of human Q fever, a zoonotic disease that can cause a debilitating, flu-like illness in acute cases, or a life-threatening endocarditis in chronic patients. An obligate intracellular bacterial pathogen, Coxiella survives and multiplies in a large lysosome-like vacuole known as the Coxiella parasitophorous vacuole (CPV). A unique characteristic of the CPV is the acidic environment (pH ∼5.0), which is required to activate Coxiella metabolism and the Coxiella type 4 secretion system (T4SS), a major virulence factor required for intracellular survival. Further, inhibiting or depleting vacuolar ATPase, a host cell protein that regulates lysosomal pH, inhibits intracellular Coxiella growth. Together, these data suggest that CPV pH is an important limiting factor for Coxiella growth and virulence. This unit describes a method to determine CPV pH using live cell microscopy of a pH-sensitive fluorophore conjugated to dextran. This technique is useful to measure changes in CPV pH during infection or in response to drug treatment. © 2017 by John Wiley & Sons, Inc.


Assuntos
Coxiella burnetii/crescimento & desenvolvimento , Técnicas Citológicas/métodos , Concentração de Íons de Hidrogênio , Vacúolos/química , Vacúolos/microbiologia , Coxiella burnetii/patogenicidade , Monitoramento de Medicamentos/métodos , Interações Hospedeiro-Patógeno , Humanos , Viabilidade Microbiana , Febre Q/tratamento farmacológico , Febre Q/microbiologia , Virulência
18.
Infection ; 45(6): 911-915, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28779434

RESUMO

BACKGROUND: Coxiella burnetii is an intracellular and fastidious bacterium responsible of acute and persistent Q fever infection. Endocarditis and vascular infections are the most common serious complications of acute Q fever. CASE REPORT: We report the case of a 63-year-old man that presented a mediastinitis associated with a prosthetic vascular infection. Serological cross-reaction was observed between Coxiella burnetii, the agent of Q fever, and Legionella pneumophila with higher antibodies titer for L. pneumophila (IgG = 1:512) than for C. burnetii (phase I IgG = 1:400). We performed western blot with cross-adsorption that supports the diagnosis of C. burnetii infection. Two weeks later, a positive qPCR and culture for C. burnetii on swab taken from the mediastinal cutaneous fistula confirmed the definitive microbiological diagnosis of Q fever mediastinitis. CONCLUSION: Cross-reactivity between C. burnetii and Legionella spp. has long been known and should be considered in patients with persistent infections. It is important to establish the definite diagnosis because the antibiotic treatment regimens and duration are significantly different. To the best of our knowledge, we reported here the first case of mediastinitis associated to C. burnetii and we diagnosed this persistent infection despite low anti-C. burnetii phase I IgG levels.


Assuntos
Anticorpos Antibacterianos/imunologia , Coxiella burnetii/imunologia , Imunoglobulina G/imunologia , Legionella pneumophila/imunologia , Mediastinite/diagnóstico , Febre Q/diagnóstico , Western Blotting , Coxiella burnetii/isolamento & purificação , Reações Cruzadas , França , Humanos , Masculino , Mediastinite/tratamento farmacológico , Mediastinite/microbiologia , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/microbiologia , Febre Q/tratamento farmacológico , Febre Q/microbiologia , Resultado do Tratamento
19.
Medicine (Baltimore) ; 96(29): e7578, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28723794

RESUMO

Q fever is a neglected and potentially fatal disease. During acute Q fever, antiphospholipid antibodies are very prevalent and have been associated with fever, thrombocytopenia, acquired heart valve disease, and progression to chronic endocarditis. However, thrombosis, the main clinical criterion of the 2006 updated classification of the antiphospholipid syndrome, has not been assessed in this context. To test whether thrombosis is associated with antiphospholipid antibodies and whether the criteria for antiphospholipid syndrome can be met in patients with acute Q fever, we conducted a cross-sectional study at the French National Referral Center for Q fever.Patients included were diagnosed with acute Q fever in our Center between January 2007 and December 2015. Each patient's history and clinical characteristics were recorded with a standardized questionnaire. Predictive factors associated with thrombosis were assessed using a rare events logistic regression model. IgG anticardiolipin antibodies (IgG aCL) assessed by an enzyme-linked immunosorbent assay were tested on the Q fever diagnostic serum. A dose-dependent relationship between IgG aCL levels and thrombosis was tested using a receiver operating characteristic (ROC) analysis.Of the 664 patients identified for inclusion in the study, 313 (47.1%) had positive IgG aCL and 13 (1.9%) were diagnosed with thrombosis. Three patients fulfilled the antiphospholipid syndrome criteria. After multiple adjustments, only positive IgG aCL (relative risk, 14.46 [1.85-113.14], P = .011) were independently associated with thrombosis. ROC analysis identified a dose-dependent relationship between IgG aCL levels and occurrence of thrombosis (area under curve, 0.83, 95%CI [0.73-0.93], P < .001).During acute Q fever, antiphospholipid antibodies are associated with thrombosis, thrombocytopenia, and acquired valvular heart disease. Antiphospholipid antibodies should be systematically assessed in acute Q fever patients. Hydroxychloroquine, which has been previously shown to antagonize IgG aCL pathogenic properties, should be tested in acute Q fever patients with anticardiolipin antibodies to prevent antiphospholipid-associated complications.Key Point: In addition to fever, thrombocytopenia and acquired valvular heart disease, antiphospholipid antibodies are associated with thrombosis during acute Q fever.


Assuntos
Síndrome Antifosfolipídica/complicações , Febre Q/complicações , Trombose/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Anticardiolipina/sangue , Síndrome Antifosfolipídica/sangue , Síndrome Antifosfolipídica/tratamento farmacológico , Síndrome Antifosfolipídica/imunologia , Criança , Estudos Transversais , Ensaio de Imunoadsorção Enzimática , Feminino , Seguimentos , França , Humanos , Imunoglobulina G/sangue , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Febre Q/sangue , Febre Q/tratamento farmacológico , Febre Q/imunologia , Curva ROC , Inquéritos e Questionários , Trombose/sangue , Trombose/tratamento farmacológico , Trombose/imunologia , Adulto Jovem
20.
Rev Esp Enferm Dig ; 109(8): 607-608, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28715899

RESUMO

Chronic Q fever is defined as an infection by Coxiella burnetii (C. burnetii) that lasts for six months or more. It occurs in 1-5% of individuals infected with this agent and develops over a period of months to years after the acute infection. Cases of hepatic involvement are rare.


Assuntos
Hepatopatias/etiologia , Febre Q/complicações , Adulto , Antibacterianos/uso terapêutico , Doença Crônica , Doxiciclina/uso terapêutico , Humanos , Fígado/patologia , Hepatopatias/tratamento farmacológico , Hepatopatias/patologia , Masculino , Febre Q/tratamento farmacológico , Febre Q/patologia
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