Acute Q Fever Hepatitis in Patients with and without Underlying Hepatitis B or C Virus Infection

Lai, Chung-Hsu; Chin, Chuen; Chung, Hsien-Ching; Huang, Chun‐Kai; Chen, Weifang; Yang, Yanling; Chen, Wency; Lin, Hans Hsienhong

doi:10.1086/520680

Cited by 19 publications

(18 citation statements)

References 23 publications

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“…In Taiwan, hepatitis rather than pneumonia is the predominant presentation of acute Q fever [28,29]. In our previous study, although all of the cases of acute Q fever had hepatitis, 19% of them had abnormal chest x-ray findings, and 9.5% had unilateral and 9.5% bilateral infiltration [29].…”

Section: Discussionmentioning

confidence: 99%

High Seroprevalence of Mycoplasma pneumoniae IgM in Acute Q Fever by Enzyme-Linked Immunosorbent Assay (ELISA)

et al. 2013

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Q fever is serologically cross-reactive with other intracellular microorganisms. However, studies of the serological status of Mycoplasma pneumoniae and Chlamydophila pneumoniae during Q fever are rare. We conducted a retrospective serological study of M. pneumoniae and C. pneumoniae by enzyme-linked immunosorbent assay (ELISA), a method widely used in clinical practice, in 102 cases of acute Q fever, 39 cases of scrub typhus, and 14 cases of murine typhus. The seropositive (57.8%, 7.7%, and 0%, p<0.001) and seroconversion rates (50.6%, 8.8%, and 0%, p<0.001) of M. pneumoniae IgM, but not M. pneumoniae IgG and C. pneumoniae IgG/IgM, in acute Q fever were significantly higher than in scrub typhus and murine typhus. Another ELISA kit also revealed a high seropositivity (49.5%) and seroconversion rate (33.3%) of M. pneumoniae IgM in acute Q fever. The temporal and age distributions of patients with positive M. pneumoniae IgM were not typical of M. pneumoniae pneumonia. Comparing acute Q fever patients who were positive for M. pneumoniae IgM (59 cases) with those who were negative (43 cases), the demographic characteristics and underlying diseases were not different. In addition, the clinical manifestations associated with atypical pneumonia, including headache (71.2% vs. 81.4%, p=0.255), sore throat (8.5% vs. 16.3%, p=0.351), cough (35.6% vs. 23.3%, p=0.199), and chest x-ray suggesting pneumonia (19.3% vs. 9.5%, p=0.258), were unchanged between the two groups. Clinicians should be aware of the high seroprevalence of M. pneumoniae IgM in acute Q fever, particularly with ELISA kits, which can lead to misdiagnosis, overestimations of the prevalence of M. pneumoniae pneumonia, and underestimations of the true prevalence of Q fever pneumonia.

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Section: Discussionmentioning

confidence: 99%

High Seroprevalence of Mycoplasma pneumoniae IgM in Acute Q Fever by Enzyme-Linked Immunosorbent Assay (ELISA)

et al. 2013

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“…Infective endocarditis is the most common complication, particularly in immunocompromised patients, pregnant patients, or those with cardiovascular abnormalities [3]. With regard to symptomatic acute Q fever, a geographic difference is found between the two major clinical presentations with pneumonia predominant in Nova Scotia, Canada [4], Switzerland [1], the north of Spain [5], and the Netherlands [6], [7] and hepatitis predominant in France [8], the south of Spain [9], California [10], Ontario, Canada [11], and Taiwan [12].…”

Section: Introductionmentioning

confidence: 99%

“…Previous retrospective studies revealed that hepatitis is the predominant presentation of acute Q fever in Taiwan [12], [22]. However, a selection bias might exist in which clinicians tend to order Q fever tests in febrile patients who present with hepatitis when no pneumonia is found on the chest-x ray.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2014

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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.

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“…Q fever is a notifiable disease and approximately 19,20 In this study, no participant had been informed of the possibility of chronic Q fever nor knew the rationale for follow-up, highlighting the importance of further education about Q fever among local physicians.…”

Section: Discussionmentioning

confidence: 99%

Serologic assessment of the risk of developing chronic Q fever in cohorts of acutely infected individuals

Hung

Lin

Hou

et al. 2011

Journal of Infection

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Acute Q Fever Hepatitis in Patients with and without Underlying Hepatitis B or C Virus Infection

Abstract: The clinical manifestations of acute Q fever hepatitis differ little in patients with and patients without underlying viral hepatitis, and replication of hepatitis virus is not influenced by acute Q fever hepatitis.

Cited by 19 publications

References 23 publications

High Seroprevalence of Mycoplasma pneumoniae IgM in Acute Q Fever by Enzyme-Linked Immunosorbent Assay (ELISA)

High Seroprevalence of Mycoplasma pneumoniae IgM in Acute Q Fever by Enzyme-Linked Immunosorbent Assay (ELISA)

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

Serologic assessment of the risk of developing chronic Q fever in cohorts of acutely infected individuals

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