Acute Q Fever Case Detection among Acute Febrile Illness Patients, Thailand, 2002–2005

SUMMARYIn May 2008 the Nijmegen Municipal Health Service (MHS) was informed about an outbreak of atypical pneumonia in three in-patients of a long-term psychiatric institution. The patients had been hospitalized and had laboratory confirmation of acute Q fever infection. The MHS started active case finding among in-patients, employees of and visitors to the institution. In a small meadow on the institution premises a flock of sheep was present. One of the lambs in the flock had been abandoned by its mother and cuddled by the in-patients. Samples were taken of the flock. Forty-five clinical cases were identified in employees, in-patients and visitors; 28 were laboratory confirmed as Q fever. Laboratory screening of pregnant women and persons with valvular heart disease resulted in one confirmed Q fever case in a pregnant woman. Of 27 samples from animals, seven were positive and 15 suspect for Coxiella burnetii infection. This outbreak of Q fever in a unique psychiatric setting pointed to a small flock of sheep with newborn lambs as the most likely source of exposure. Care institutions that have vulnerable residents and keep flocks of sheep should be careful to take adequate hygienic measures during delivery of lambs and handling of birth products.

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First Identification and Description of Rickettsioses and Q Fever as Causes of Acute Febrile Illness in Nicaragua

PLoS Neglected Tropical Diseases ◽

10.1371/journal.pntd.0005185 ◽

2016 ◽

Vol 10 (12) ◽

pp. e0005185 ◽

Cited By ~ 8

Author(s):

Megan E. Reller ◽

Ijeuru Chikeka ◽

Jeremy J. Miles ◽

J. Stephen Dumler ◽

Christopher W. Woods ◽

...

Keyword(s):

Q Fever ◽

Febrile Illness ◽

Acute Febrile Illness

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West nile fever case in neurological practice

Innovative medicine of Kuban ◽

10.35401/2500-0268-2021-24-4-63-66 ◽

2021 ◽

pp. 63-66

Author(s):

P. V. Kataev ◽

L. V. Timchenko ◽

S. V. Zotov ◽

A. N. Torgashova ◽

Dz. K. Sichinava

Keyword(s):

Culex Pipiens ◽

Hemorrhagic Stroke ◽

Febrile Illness ◽

Acute Febrile Illness ◽

West Nile Fever ◽

West Nile ◽

Central Nervous System Damage ◽

Fever Case ◽

Mass Tourism ◽

The Central Nervous System

West Nile fever is a zoonotic arbovirus mosquito- and tick-borne infection, which occurs in humans in the form of an acute febrile illness with symptoms of general intoxication, in severe cases – with the central nervous system damage. West Nile virus belongs to the Flaviviridae family.After the start of Russians’ mass tourism to tropical and subtropical regions, number of cases of the disease in Russia has increased, especially in the south, where the virus is more viable. The infection mainly affects birds but also people and many mammals (bats, cats, dogs, skunks, squirrels, rabbits, etc.), which become infected after the bite of a mosquito of the genus Culex (Culex pipiens) carrying the disease, ixodid or argas mite. A clinical case of hemorrhagic stroke caused by West Nile fever is presented in the article.

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Epidemiological, clinical and laboratory characteristics of acute Q fever in an endemic area in Israel, 2006–2016

Epidemiology and Infection ◽

10.1017/s0950268818003576 ◽

2019 ◽

Vol 147 ◽

Cited By ~ 1

Author(s):

S. Reisfeld ◽

S. Hasadia Mhamed ◽

M. Stein ◽

M. Chowers

Keyword(s):

Endemic Area ◽

Q Fever ◽

Febrile Illness ◽

Definite Diagnosis ◽

Febrile Patient ◽

Rural Regions ◽

Historical Cohort ◽

Common Mean ◽

Acute Q Fever ◽

Autumn And Winter

AbstractOur purpose was to describe the clinical, epidemiological and laboratory characteristics of patients hospitalised with acute Q fever in an endemic area of Israel. We conducted a historical cohort study of all patients hospitalised with a definite diagnosis of acute Q fever, and compared them to patients suspected to have acute Q fever, but diagnosis was ruled out. A total of 38 patients had a definitive diagnosis, 47% occurred during the autumn and winter seasons, only 18% lived in rural regions. Leucopaenia and thrombocytopaenia were uncommon (16% and 18%, respectively), but mild hepatitis was common (mean aspartate aminotransferase 76 U/l, mean alanine aminotransferase 81 U/l). We compared them with 74 patients in which acute Q fever was ruled out, and found that these parameters were not significantly different. Patients with acute Q fever had a shorter hospitalisation and they were treated more often with doxycycline than those without acute Q fever (6.4vs. 14 days,P= 0.007, 71%vs. 38%,P= 0.001, respectively). In conclusion, acute Q fever can manifest as an unspecified febrile illness, with no seasonality. We suggest that in endemic areas, Q fever should be considered in the differential diagnosis in any febrile patient with risk factors for a persistent infection.

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Acute Glomerulonephritis Associated with Acute Q Fever: Case Report and Review of the Renal Complications ofCoxiella burnetiiInfection

Clinical Infectious Diseases ◽

10.1086/516308 ◽

1998 ◽

Vol 26 (2) ◽

pp. 359-364 ◽

Cited By ~ 22

Author(s):

Tony M. Korman ◽

Denis W. Spelman ◽

Greg J. Perry ◽

John P. Dowling

Keyword(s):

Case Report ◽

Q Fever ◽

Acute Glomerulonephritis ◽

Fever Case ◽

Renal Complications ◽

Acute Q Fever

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Influenza B, Q Fever and the consequences of febrile illness occurring during Jungle Warfare Training: a clinical and serological study

Journal of The Royal Naval Medical Service ◽

10.1136/jrnms-75-13 ◽

1989 ◽

Vol 75 (1) ◽

pp. 13-18

Author(s):

M. C. J. Wale

Keyword(s):

Q Fever ◽

Febrile Illness ◽

Influenza B ◽

Serological Study ◽

Serological Evidence ◽

Heat Exhaustion ◽

Acute Q Fever

AbstractSeventy-one Royal Marines undergoing jungle warfare training were studied clinically and serologically to determine the incidence and consequences of febrile illness. During acclimatisation and the early part of the deployment the incidence of illness having an impact on training was low; during the latter part an outbreak of influenza B occurred, with 25 cases diagnosed clinically. Only 12 of these were confirmed serogically, probably because the outbreak was still in progress when the second samples were taken. A further four subclinical cases were uncovered by the serological study.Five cases of heat exhaustion occurred, one Marine suffering two episodes. Four patients required casevac from the jungle. Three Marines were found to have serological evidence of previous acute Q fever, including the patient who had two episodes of heat exhaustion. This incidence is higher than expected, and warrants further investigation.

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Q Fever

Clinical Microbiology Reviews ◽

10.1128/cmr.12.4.518 ◽

1999 ◽

Vol 12 (4) ◽

pp. 518-553 ◽

Cited By ~ 1169

Author(s):

M. Maurin ◽

D. Raoult

Keyword(s):

Q Fever ◽

Febrile Illness ◽

Protective Role ◽

Immunoglobulin M ◽

Worldwide Distribution ◽

Cell Extracts ◽

Chronic Q Fever ◽

Acute Q Fever ◽

High Level ◽

Immunocompromised Hosts

SUMMARY Q fever is a zoonosis with a worldwide distribution with the exception of New Zealand. The disease is caused by Coxiella burnetii, a strictly intracellular, gram-negative bacterium. Many species of mammals, birds, and ticks are reservoirs of C. burnetii in nature. C. burnetii infection is most often latent in animals, with persistent shedding of bacteria into the environment. However, in females intermittent high-level shedding occurs at the time of parturition, with millions of bacteria being released per gram of placenta. Humans are usually infected by contaminated aerosols from domestic animals, particularly after contact with parturient females and their birth products. Although often asymptomatic, Q fever may manifest in humans as an acute disease (mainly as a self-limited febrile illness, pneumonia, or hepatitis) or as a chronic disease (mainly endocarditis), especially in patients with previous valvulopathy and to a lesser extent in immunocompromised hosts and in pregnant women. Specific diagnosis of Q fever remains based upon serology. Immunoglobulin M (IgM) and IgG antiphase II antibodies are detected 2 to 3 weeks after infection with C. burnetii, whereas the presence of IgG antiphase I C. burnetii antibodies at titers of ≥1:800 by microimmunofluorescence is indicative of chronic Q fever. The tetracyclines are still considered the mainstay of antibiotic therapy of acute Q fever, whereas antibiotic combinations administered over prolonged periods are necessary to prevent relapses in Q fever endocarditis patients. Although the protective role of Q fever vaccination with whole-cell extracts has been established, the population which should be primarily vaccinated remains to be clearly identified. Vaccination should probably be considered in the population at high risk for Q fever endocarditis.

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211. Coxiella burnetii: 7 Years of Experience at a Tertiary-Care Center

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.286 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S124-S125

Author(s):

Pooja Gurram ◽

F N U Shweta ◽

Natalia E Castillo Almeida ◽

Sarwat Khalil ◽

Edison J Cano Cevallos ◽

...

Keyword(s):

Risk Factors ◽

Coxiella Burnetii ◽

Persistent Infection ◽

Q Fever ◽

Care Center ◽

Tertiary Care ◽

Febrile Illness ◽

Case Definition ◽

Common Presentation ◽

Acute Q Fever

Abstract Background Q fever is a zoonotic disease caused by Coxiella burnetii. Primary infection can progress to persistent infection irrespective of initial symptomatology. Our aim is to describe the clinical features, treatment, risk of progression, use of prophylaxis, and outcomes of Coxiella burnetii infection at our institution. Methods We did a retrospective review of all adult patients with positive Coxiella burnetii serology at Mayo Clinic, Rochester from 1st January 2012 to 31st December 2018. Centers for Disease Control and Prevention (CDC) case definition and classification were used to group the patients into confirmed and probable acute Q fever, and confirmed and probable chronic/persistent Q fever. Data on demographics, clinical presentation, comorbid conditions, exposure history, risk factors associated with progression, serology, treatment and outcomes were collected. Results We found 266 patients with positive titres of Coxiella IgG or IgM greater than 1:16, of which 49 patients met the CDC case definition for Q fever. Median age at presentation was 62 years. 45/49 (91. 8%) were men, while 4/49 (8%) were women. 20/49 (40. 8%) patients presented with acute Q fever of which 5 (25%) patients progressed to persistent infection. 29/49 (59%) patients presented with persistent Q fever of which 4 patients could recall symptoms suggestive of acute Q fever. The most common presentation of acute Q fever was acute febrile illness (65%). Endocarditis (11/29) was the most common presentation of chronic/persistent Q fever. Of the 5 patients with acute Q fever that progressed to persistent infection, 3/5(60%) progressed despite being on doxycycline and hydroxychloroquine. 8/29 patients with persistent Q fever had serological resolution at last follow-up. 2/4(50%) deaths were attributable to Q fever. Conclusion Minority of the patients tested met the case definition. 25% of patients with acute disease progressed to chronic Q fever out of which 60%(3/5) progressed despite prophylaxis. Endocarditis and vascular infections were the most common chronic cases. Interestingly we found 4 cases of MPGN in association with Q fever. Prosthetic valves are the most important risk factors for progression (P = 0.02). Serological cure often lags behind clinical cure (27% vs. 68% in persistent infection)(Table 4). Disclosures All authors: No reported disclosures.

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