Investigation of Coxiella burnetii and Brucella Seropositivities in Patients Presenting with Acute Fever

Abstract

Tokat province and Kelkit Valley located in the Black Sea region of Turkey are endemic areas for brucellosis and Crimean-Congo hemorrhagic fever. Since the risk factors are similar, the probability of Coxiella burnetii seroposititivity is assumed to be also high in this area. The aim of this study was to investigate Q fever and brucellosis seropositivity in patients with acute fever. A total of 53 patients (37 male, 16 female; age range: 18-65 years, mean age: 47.13 ± 16.40 years) who were admitted to the emergency room and infection diseases outpatient clinics of Gaziosmanpasa University hospital with acute fever between June 2011-June 2012 were included in the study. Symptoms, physical examination findings and laboratory test results of the patients were recorded. In addition, their place of residence, relationship with rural area, and history of contacts with animals were questioned. The presence of C.burnetii phase II lgM and lgG antibodies were investigated by indirect immunofluorescent antibody assay, and Brucella spp. antibodies by Rose Bengal and standard tube agglutination methods in the serum samples of patients. C.burnetii seropositivity was determined in 19 (36%) of the patients, and 2 (4%) of them were diagnosed as acute Q fever with the positivity of both lgG and lgM antibodies. Among the seropositive and seronegative patients, there was no statistically significant differences in terms of age, gender, animal contact, occupation, place of residence and relationship with rural-life (p> 0.05). Acute fever was attributed to pneumonia in 10 patients and of them five were found positive for phase II lgG antibodies. There was no significant difference between C.burnetii seropositive and seronegative patients in terms of the presence of pneumonia (p= 0.30). In two patients diagnosed as acute Q fever no signs of pneumoniae were detected in the chest X-rays; one of these cases was resided in the city and the other in the rural area while both had contact with animals. The most frequently detected symptoms in patients with acute Q fever were malaise, fatigue, chills, cough, sputum, dyspnea, nausea, abdominal pain and diarrhea. Brucella seropositivity was detected in 6 (11%) patients and four of them were diagnosed as acute brucellosis. Four of the Brucella seropositive patients were also found positive for C.burnetii. Sixteen (84%) of C.burnetii seropositive patients were male and 3 (16%) were female. Eleven of them were living in the village and eight in the city, however six out of eight urban patients had a history of relation with rural-life, resulting a total of 17 (89%) rural-contacts. In addition, 79% (15/19) of seropositive cases had the history of animal contact most commonly with cattle and sheep (11/15; 73%). When the laboratory findings were compared, serum ferritin levels were found to be significantly higher in patients with acute Q fever then those seronegative patients (874 ng/ml mean value vs. 150 ng/mL mean value; p= 0.04), however there was no significant difference between the other labora...

A comparison of patients with Q fever fatigue syndrome and patients with chronic fatigue syndrome with a focus on inflammatory markers and possible fatigue perpetuating cognitions and behaviour

“…Ferritin, a cellular storage protein for iron that is important in iron absorption control, orchestrates cellular defence against A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT 11.06.2015 oxidative stress and inflammation and is an acute phase reactant. It is induced by cytokines such as interleukin (IL)-6 and IL-18, and has been found to be significantly higher in acute Q fever patients than in controls [14]. .…”

Rickettsia burneti and Brucella melitensis co-infection: a case report and literature review

“…These two diseases can be prevalent in the same area at the same time, and the same patient (or animal) will be infected with these two diseases at the same time, which poses a great threat to human and animal health and public safety, and also causes great losses to the world economy. Up to now, few cases of mixed infection of Brucella and rickettsia burgdorferi have been reported [ 4 , 5 ]. In PubMed, we found only one similar case report [ 6 ].…”

Rickettsia burneti and Brucella melitensis co-infection: a case report and literature review

“…Acute Q feve can cause pneumonia, meningo-encephalitis, hepatitiss and endocarditis in chronic cases [3].Two diseases will be prevalent in the same area at the same time, and the same patient (or animal) will also be co-infected with the two diseases, posing a great threat to human and animal health and public safety, and also causing huge losses to the world economy. So far, the cases of coinfection of Brucella and Rickettsia burneti have been rarely reported [4,5]. In PubMed, we found only one similar case report [6].…”