Clinical Characteristics of Q Fever and Etiology of Community-Acquired Pneumonia in a Tropical Region of Southern Taiwan: A Prospective Observational Study

Abstract

BackgroundThe clinical characteristics of Q fever are poorly identified in the tropics. Fever with pneumonia or hepatitis are the dominant presentations of acute Q fever, which exhibits geographic variability. In southern Taiwan, which is located in a tropical region, the role of Q fever in community-acquired pneumonia (CAP) has never been investigated.Methodology/Principal FindingsDuring the study period, May 2012 to April 2013, 166 cases of adult CAP and 15 cases of acute Q fever were prospectively investigated. Cultures of clinical specimens, urine antigen tests for Streptococcus pneumoniae and Legionella pneumophila, and paired serologic assessments for Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Q fever (Coxiella burnetii) were used for identifying pathogens associated with CAP. From April 2004 to April 2013 (the pre-study period), 122 cases of acute Q fever were also included retrospectively for analysis. The geographic distribution of Q fever and CAP cases was similar. Q fever cases were identified in warmer seasons and younger ages than CAP. Based on multivariate analysis, male gender, chills, thrombocytopenia, and elevated liver enzymes were independent characteristics associated with Q fever. In patients with Q fever, 95% and 13.5% of cases presented with hepatitis and pneumonia, respectively. Twelve (7.2%) cases of CAP were seropositive for C. burnetii antibodies, but none of them had acute Q fever. Among CAP cases, 22.9% had a CURB-65 score ≧2, and 45.8% had identifiable pathogens. Haemophilus parainfluenzae (14.5%), S. pneumoniae (6.6%), Pseudomonas aeruginosa (4.8%), and Klebsiella pneumoniae (3.0%) were the most common pathogens identified by cultures or urine antigen tests. Moreover, M. pneumoniae, C. pneumoniae, and co-infection with 2 pathogens accounted for 9.0%, 7.8%, and 1.8%, respectively.ConclusionsIn southern Taiwan, Q fever is an endemic disease with hepatitis as the major presentation and is not a common etiology of CAP.

The Epidemiology and Characteristics of Q fever and Co‐infections with Scrub Typhus, Murine Typhus or Leptospirosis in Taiwan: A Nationwide Database Study

“…The findings from this database study were similar to our previous clinical study of QF in southern Taiwan, including the high percentages of male gender, high-risk occupations and residence in the southern and Kaohsiung-Pingtung regions among confirmed cases of QF (Lai et al, 2007(Lai et al, , 2008(Lai et al, , 2014a(Lai et al, , 2015. The predominant season, age range and male gender were similar to those reported from other countries (Frankel et al, 2011;Dijkstra et al, 2012;Kwak et al, 2013;Dahlgren et al, 2015).…”

“…Notably, although QF is a zoonosis, the percentages of contact with any animal (29.8%), cattle (0.6%) and goats (0.9%) were low in confirmed QF cases and did not differ from non-QF cases (Table 1). In addition, these rates were much lower than the results revealed by clinical case studies of 42.3% for any animal and 16.8% for goat contact (Lai et al, 2014a). The difference between a clinical case study and the suspected case database analysis might have resulted from different personnel collecting information.…”

“…Having a high‐risk occupation and animal exposure are the most considerable risk factors emphasized for clinical suspicion of QF. We previously observed that 3.6% and 16.8% of human QF cases had exposure histories to cattle and goats, respectively (Lai et al., ). In addition, 32.1% had histories of rural travel, 12.4% were farmers, and only 2.2% were employed in animal husbandry, but these rates did not differ from those of the comparison.…”

“…Thus, co‐infection of QF with ST (Lai et al., ), MT (Chang et al., ), and other rickettsioses (Lai et al., ) has been clinically identified by reporting suspected both these diseases and QF simultaneously to the Centers for Disease Control, Taiwan (Taiwan CDC). Although several studies have reported the epidemiology and clinical characteristics of QF in Taiwan, all of these studies were single‐centre, retrospective and clinical studies (Lai et al., , ,c, ).…”

New insight into bacterial zoonotic pathogens posing health hazards to humans

“…Choroba ta Nr 6 824 objawów z dominującymi bólami głowy i mięśni oraz nieproduktywnym kaszlem mogą wystąpić biegunki i wymioty. Najpoważniejszym powikłaniem jest zapalenie wsierdzia (zwłaszcza zastawek serca), które nawet mimo prawidłowego leczenia powoduje śmiertelność na poziomie 10% (29,30).…”