Liver Involvement in “Q” Fever

Abstract

Summary In 72 consecutive cases of “Q” fever, hepatomegaly occurred in 47, and jaundice in three. Abnormal results for serum cephalin‐cholesterol flocculation, thymol turbidity or serum alkaline phosphatase activity were found in 61 cases. The test that most commonly produced an abnormal result was the cephalin‐cholesterol flocculation test (56 cases); this was followed by the serum alkaline phosphatase estimation (26 cases) and the thymol turbidity test (25 cases). During the first four weeks, the serum alkaline phosphatase level was related to the degree of cephalin‐cholesterol flocculation. Positive cephalin‐cholesterol flocculation commonly persisted for several months. Increased serum alkaline phosphatase levels were frequently the first, and occasionally the only, biochemical evidence of liver involvement. Quite high values were seen at times. Serum transaminase activity was only moderately increased, even in jaundiced patients. Liver biopsy was performed on 13 patients of the series, and on an additional jaundiced patient admitted to hospital subsequently. The predominant histological pattern was one of focal inflammation. This was of all grades, from small collections of mixed inflammatory cells to frank granulomas with central necrosis and fibroblastic reaction. In one patient a focal inflammatory lesion was found in the liver 17 weeks after the onset of the illness.

Serological evaluation of O fever in humans: enhanced phase I titers of immunoglobulins G and A are diagnostic for Q fever endocarditis

“…Coxiella burnetii causes infections in humans that may be subclinical or acute (classical Q fever) or lead to chronic disease (endocarditis or granulomatous hepatitis) (3,5,18,19,20,21,26,31,33,38,40,42,45,46). Recent reports of human infection acquired from sheep have renewed concern about the occurrence of Q fever, particularly in its chronic form, in the United States (4,11,23,37).…”

The Liver Lesion in Q Fever

“…Additional laboratory studies disclosed the following values : BUN, 14 mg/100 ml ; serum albumin, 3.9 gm/100 ml ; serum globulin, 3.4 gm/ 100 ml; serum bilirubin, 1.5 mg/100 ml; serum alkaline phosphatase, 2.8 Bessey-Lowry units; thy¬ mol turbidity, 2 units ; prothrombin activity, 90% ; SGOT, 38 units ; and cephalin flocculation, 4+. Urinalysis showed a trace of albumin and a slight trace of sugar and acetone.…”

“…Review of the literature, including the series by Powell,3 suggests that thymol turbidity and cephalin flocculation or equivalent tests are consist¬ ently abnormal when there is hepatic in¬ volvement. The abnormalities of serum albumin, globulin, total cholesterol and cholesterol esters, alkaline phosphatase, and bilirubin were variable and, if present, were slight.…”

Q fever.

“…More common are simple elevations in liver function test results and jaundice. Hepatomegaly, hepatic tenderness, and jaundice are seen in as few as 10% of cases in some series and in as many as 65% in others (19,59). Isolated elevation of liver function tests has been seen in 65 to 85% of cases (59,70).…”