Diverse and atypical manifestations of Q fever in a metropolitan city hospital: Emerging role of next-generation sequencing for laboratory diagnosis of Coxiella burnetii

Abstract

Although Q fever has been widely reported in the rural areas of China, there is a paucity of data on the epidemiology and clinical characteristics of this disease in large metropolitan cities. In this study, we profile the epidemiology and clinical manifestations of Q fever from a tertiary hospital in Shenzhen, a Southern Chinese metropolitan city with a large immigrant population from other parts of China. A total of 14 patients were confirmed to have Q fever during a nine-year-and-six-month period, five of whom were retrospectively diagnosed during case review or incidentally picked up because of another research project on unexplained fever without localizing features. Some patients had the typical exposure histories and clinical features, while a few other patients had rare manifestations of Q fever, including one with heart failure and diffuse intracapillary proliferative glomerulonephritis, a patient presenting with a spontaneous bacterial peritonitis-like syndrome, and another one with concomitant Q fever and brucellosis. Using a combination of clinical manifestation, inflammatory marker levels, echocardiographic findings and serological or molecular test results, nine, three and two patients were diagnosed to have acute, chronic and convalescent Q fever, respectively. Seven, five and two patients were diagnosed to have Q fever by serological test, nested real-time PCR and next-generation sequencing respectively. Diverse and atypical manifestations are associated with Q fever. The incidence of Q fever is likely to be underestimated. Next-generation sequencing is becoming an important diagnostic modality for culture-negative infections, particularly those that the physicians fail to recognize clinically, such as Q fever.

Diagnosis of Acute Q Fever in a Patient by Using Metagenomic Next-Generation Sequencing: A Case Report

“…Metagenomic next-generation sequencing (mNGS) can detect a wide range of pathogens, including those that are difficult to culture, and can provide comprehensive coverage of pathogen species through direct detection of nucleic acids, which has a high reference value for the clinical diagnosis of new infections, complex infections, mixed infections and unknown pathogens. [11][12][13] In this case, a patient who presented with an acute onset of high fever, lethargy, pulmonary infection, and liver damage was initially misdiagnosed as pneumonia. However, C. burnetii was detected by mNGS as the causative pathogen of Q fever, which guided efficient clinical medication and treatment.…”

miR‐8485 alleviates the injury of cardiomyocytes through TP53INP1

“…[1] CHF is caused by myocardial infarction, cardiomyopathy, hemodynamic overload, inflammation, leading to changes in myocardial structure and function. [2,3] It is vital to clarify the pathogenesis of CHF, and improve the diagnosis and treatment of CHF.…”

Usefulness of Next-Generation Sequencing in Excluding Bovine Leukemia Virus as a Cause of Adult Camel Leukosis in Dromedaries

“…In the clinical setting for human infections, NGS is used most often for patients who have a fever without localizing features, or for culture-negative infections. For example, we have recently reported its application in confirming the first case of listeria meningitis in a patient with an autoantibody against interferon gamma, as well as understanding the spectrum of Q fever, fungal infections and culture-negative meningitis and encephalitis [10][11][12][13]. As for animals, the application of NGS to veterinary testing has been reported in the literature, ranging from shotgun metagenomics for novel/known pathogen detection to amplicon sequencing for targeted detection of multiple pathogens in animal samples [14][15][16].…”