Neurological Involvement in Acute Q Fever

Bernit, Emmanuelle; Pouget, Jean; Janbon, F; Dutronc, H.; Martinez, Philippe; Brouqui, Philippe; Raoult, Didier

doi:10.1001/archinte.162.6.693

Cited by 88 publications

(16 citation statements)

References 38 publications

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“…Relative bradycardia was also observed, which has been described previously [2], [21], [41], [42]. We observed two cases of Guillain-Barré syndrome – which is a rare, but previously described complication of acute Q fever [7], [43], [44]. Additional microbiological testing revealed the presence of antibodies against M. pneumoniae in 22 patients, although only two met our definition, which required an antibody titre≥1∶320.…”

Section: Discussionsupporting

confidence: 61%

Characteristics of Hospitalized Acute Q Fever Patients during a Large Epidemic, The Netherlands

et al. 2014

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BackgroundFrom 2007 to 2009, the Netherlands experienced a major Q fever epidemic, with higher hospitalization rates than the 2–5% reported in the literature for acute Q fever pneumonia and hepatitis. We describe epidemiological and clinical features of hospitalized acute Q fever patients and compared patients presenting with Q fever pneumonia with patients admitted for other forms of community-acquired pneumonia (CAP). We also examined whether proximity to infected ruminant farms was a risk factor for hospitalization.MethodsA retrospective cohort study was conducted for all patients diagnosed and hospitalized with acute Q fever between 2007 and 2009 in one general hospital situated in the high incidence area in the south of the Netherlands. Pneumonia severity scores (PSI and CURB-65) of acute Q fever pneumonia patients (defined as infiltrate on a chest x-ray) were compared with data from CAP patients. Hepatitis was defined as a >twofold the reference value for alanine aminotransferase and for bilirubin.ResultsAmong the 183 hospitalized acute Q fever patients, 86.0% had pneumonia. Elevated liver enzymes (alanine aminotransferase) were found in 32.3% of patients, although hepatitis was not observed in any of them. The most frequent clinical signs upon presentation were fever, cough and dyspnoea. The median duration of admission was five days. Acute Q fever pneumonia patients were younger, had less co-morbidity, and lower PSI and CURB-65 scores than other CAP patients. Anecdotal information from attending physicians suggests that some patients were admitted because of severe subjective dyspnoea, which was not included in the scoring systems. Proximity to an infected ruminant farm was not associated with hospitalization.ConclusionHospitalized Dutch acute Q fever patients mostly presented with fever and pneumonia. Patients with acute Q fever pneumonia were hospitalized despite low PSI and CURB-65 scores, presumably because subjective dyspnoea was not included in the scoring systems.

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Section: Discussionsupporting

confidence: 61%

Characteristics of Hospitalized Acute Q Fever Patients during a Large Epidemic, The Netherlands

et al. 2014

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“…The main clinical signs in neurological cases are headaches, behavioral problems, cognitive deficiency, or confusion. Convulsions and even epileptic fits and aphasia are possible [196–198]. In pregnant women, chronic Q fever can lead to spontaneous abortions in future pregnancies [109, 117, 199].…”

Section: Epidemiological and Clinical Aspectsmentioning

confidence: 99%

Q Fever: Current State of Knowledge and Perspectives of Research of a Neglected Zoonosis

Porter

Czaplicki²,

Mainil

et al. 2011

International Journal of Microbiology

195

201

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Q fever is an ubiquitous zoonosis caused by an resistant intracellular bacterium, Coxiella burnetii. In certain areas, Q fever can be a severe public health problem, and awareness of the disease must be promoted worldwide. Nevertheless, knowledge of Coxiella burnetii remains limited to this day. Its resistant (intracellular and environmental) and infectious properties have been poorly investigated. Further understanding of the interactions between the infected host and the bacteria is necessary. Domestic ruminants are considered as the main reservoir of bacteria. Infected animals shed highly infectious organisms in milk, feces, urine, vaginal mucus, and, very importantly, birth products. Inhalation is the main route of infection. Frequently asymptomatic in humans and animals, Q fever can cause acute or chronic infections. Financial consequences of infection can be dramatic at herd level. Vaccination with inactive whole-cell bacteria has been performed and proved effective in humans and animals. However, inactive whole-cell vaccines present several defects. Recombinant vaccines have been developed in experimental conditions and have great potential for the future. Q fever is a challenging disease for scientists as significant further investigations are necessary. Great research opportunities are available to reach a better understanding and thus a better prevention and control of the infection.

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“…Other manifestations comprise erythema, pericarditis and/or myocarditis, meningitis, encephalitis [273-275] and myelitis [276, 277]. …”

Section: Q Fevermentioning

confidence: 99%

Chronic Lyme Disease and Co-infections: Differential Diagnosis

Berghoff¹

2012

TONEUJ

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In Lyme disease concurrent infections frequently occur. The clinical and pathological impact of co-infections was first recognized in the 1990th, i.e. approximately ten years after the discovery of Lyme disease. Their pathological synergism can exacerbate Lyme disease or induce similar disease manifestations. Co-infecting agents can be transmitted together with Borrelia burgdorferi by tick bite resulting in multiple infections but a fraction of co-infections occur independently of tick bite. Clinically relevant co-infections are caused by Bartonella species, Yersinia enterocolitica, Chlamydophila pneumoniae, Chlamydia trachomatis, and Mycoplasma pneumoniae. In contrast to the USA, human granulocytic anaplasmosis (HGA) and babesiosis are not of major importance in Europe. Infections caused by these pathogens in patients not infected by Borrelia burgdorferi can result in clinical symptoms similar to those occurring in Lyme disease. This applies particularly to infections caused by Bartonella henselae, Yersinia enterocolitica, and Mycoplasma pneumoniae. Chlamydia trachomatis primarily causes polyarthritis. Chlamydophila pneumoniae not only causes arthritis but also affects the nervous system and the heart, which renders the differential diagnosis difficult. The diagnosis is even more complex when co-infections occur in association with Lyme disease. Treatment recommendations are based on individual expert opinions. In antibiotic therapy, the use of third generation cephalosporins should only be considered in cases of Lyme disease. The same applies to carbapenems, which however are used occasionally in infections caused by Yersinia enterocolitica. For the remaining infections predominantly tetracyclines and macrolides are used. Quinolones are for alternative treatment, particularly gemifloxacin. For Bartonella henselae, Chlamydia trachomatis, and Chlamydophila pneumoniae the combination with rifampicin is recommended. Erythromycin is the drug of choice for Campylobacter jejuni.

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Neurological Involvement in Acute Q Fever

Abstract: Q fever should be included in the differential diagnosis of acute neurological disease in a patient with a fever. Serological testing should be performed in cases of meningoencephalitis, lymphocytic meningitis, and peripheral neuropathy, including Guillain-Barré syndrome and myelitis.

Cited by 88 publications

References 38 publications

Characteristics of Hospitalized Acute Q Fever Patients during a Large Epidemic, The Netherlands

Characteristics of Hospitalized Acute Q Fever Patients during a Large Epidemic, The Netherlands

Q Fever: Current State of Knowledge and Perspectives of Research of a Neglected Zoonosis

Chronic Lyme Disease and Co-infections: Differential Diagnosis

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