Serological diagnosis of Q fever endocarditis

The diagnosis of Q fever endocarditis cannot be made by bacterialcultures and necessitates serological identification of specificantibodies to Coxiella burnetii which stimulates mainly theproduction of anti-phase II antibodies during the acute diséase,but primarily anti-phase I antibodies in endocarditis. Indirectmicro-immunofluorescence allows rapid detection of specificIgA, IgG and IgM. The results of serological analyses of 191acute cases of Q fever were compared with those of 8 cases ofCoxiella burnetii endocarditis. All sera were evaluated by complementfixation and microimmunofluorescence tests. The highest titredifferences between primary Q fever and Q fever endocarditiswere observed with anti-phase IIgA and IgG antibodies measuredby microimmunofluorescence followed by anti-phase I antibodiesmeasured by complement fixation tests. Anti-phase IIgG and IgMtitres were consistently higher than anti-phase II titres inendocarditis. The reverse is true in acute Q fever. In addition,anti-phase I Ig A appeared to be diagnostic for Coxiella burnetiiendocarditis. Accordingly we recommend the testing of thesespecific IgA, IgG, and IgM by microimmunofluorescence in casesof culture-negative endocarditis. These tests could also proveuseful for following the development of Coxiella burnetii endocarditisin patients under treatment.     

Q fever cases at a North Queensland centre during 1994-2006

This study reviewed the epidemiological features, management and outcomes of patients with Q fever treated at a tertiary facility in North Queensland during the period from July 1994 to January 2006. Twenty-seven patients were identified. Our findings were consistent with the observations about Q fever that have been made in other regions of Australia. A diagnosis of Q fever should be considered in patients with a non-specific febrile illness.     

Two rare severe and fulminant presentations of Q fever in patients with minimal risk factors for this disease

We described two rare severe and fulminant clinical presentations of acute Q fever. The first patient had severe multiorgan failure. The second patient had fever and severe cholera-like diarrhoea. Coxiella burnetii polymerase chain reaction on blood or serum can be clinically useful in the diagnosis of acute Q fever before seroconversion.     

Acute Q fever in pregnancy: report and literature review

Acute Q fever in pregnancy is uncommon, but is probably underrecognized. It results in a significant risk of adverse pregnancy outcome and also predisposes to the development of chronic Q fever in the mother. Here, we review the clinical features, epidemiology, treatment and follow-up of acute Q fever in pregnancy. The potential for transmission of Coxiella to the neonate and birthing suite staff will also be highlighted.     

1例Q热肺炎诊治报告北大核心CSCD

Q热是一种重要的人兽共患病,病原体为贝氏柯克斯体(Coxiella burnetii),其经呼吸道吸入进入体内,引起急性Q热,严重急性Q热可出现肺炎、肝炎或心肌炎并发症。部分患者治疗不彻底转为慢性Q热。慢性Q热为贝氏柯克斯体在机体局部持续感染,常需要外科手术及数年抗感染治疗,其严重危害患者身体健康及加重家庭经济负担;。追其原因是临床医生对该病认识不足,导致延误治疗所致。本文旨在报告1例Q热肺炎的诊治和体会,以提高临床医生对该病认识。     

氯仿-甲醇提取贝氏柯克斯体组分Q热疫苗的安全性评价

目的评价采用国内分离株研制的氯仿-甲醇提取贝氏柯克斯体组分Q热疫苗(CMRV)的安全性。方法分别用3批CMRV和灭活贝氏柯克斯体Q热疫苗(WCV)致敏豚鼠,4w后用相同疫苗对致敏豚鼠作皮肤试验。结果CMRV致敏豚鼠与WCV致敏豚鼠的皮试点红肿大小在皮试后1～6d无显著差异,但是从第7d开始,差异显著。皮试后第14d采集接种部位组织做病理切片,WCV致敏豚鼠皮试点的表皮组织有局灶性变性、坏死,并见大量炎性细胞浸润。CMRV致敏豚鼠的皮试点组织基本正常,少数豚鼠偶见局灶性变性,但无坏死现象。3批CMRV致敏豚鼠皮试点组织病变程度相似,均显著轻于WCV致敏豚鼠。结论采用国内分离株研制的氯仿-甲醇提取贝氏柯克斯体组分Q热疫苗的免疫副作用显著轻于灭活Q热疫苗,具有更好的安全性。     

Q热疫苗研究

Q热(Q fever)为一种世界性分布的重要人兽共患病,疫苗接种是预防Q热的最有效手段。专性细胞内寄生的贝氏柯克斯体是Q热的病原体,灭活I相贝氏柯克斯体Q热疫苗(WCV)免疫保护效能几乎为100%,但是其免疫副反应强。氯仿-甲醇提取贝氏柯克斯体(CMR)和三氯醋酸提取贝氏柯克斯体可溶性抗原(TCA)Q热疫苗保留灭活Q热疫苗的免疫保护效能,且免疫副反应显著减轻。但CMR和TCA Q热疫苗均需要用鸡胚大量培养贝氏柯克斯体,需要在高等级生物防护实验室采用复杂步骤提取、纯化贝氏柯克斯体,这些使Q热疫苗的生产成本高、批量生产难。近十年来,国内外Q热疫苗研究着力于分子疫苗,并已经由研究贝氏柯克斯体保护性抗原转移到筛选能诱导特异性细胞免疫应答的CD4⁺和CD8⁺T细胞表位上,以期望T细胞表位在机体内高效表达,诱导机体产生良好的抗Q热保护性免疫应答。     

A case of Q fever after liver transplantation

Coxiella burnetii, the causative agent of Q fever, is a zoonosis that causes both acute and chronic disease in humans. Few cases have been reported in solid organ transplant recipients, and this case highlights the need to include Q fever in the differential diagnosis for fever of unknown origin in solid organ transplant hosts.     

氯仿-甲醇提取贝氏柯克斯体残存组分Q热疫苗的免疫原性及免疫保护性研究

目的实验评价氯仿-甲醇提取贝氏柯克斯体残存组分(CMR)疫苗的免疫特性及免疫保护性。方法采用国内分离贝氏柯克斯体新桥株制备CMR疫苗,用CMR免疫Balb/c小鼠;采用间接免疫荧光法检测CMR免疫小鼠血清特异性抗体水平和用淋巴细胞增殖试验评价CMR疫苗体外刺激小鼠脾细胞增殖的能力;以贝氏柯克斯体攻击免疫小鼠和用贝氏柯克斯体特异的荧光定量PCR检测感染小鼠血和脾脏样本。结果CMR免疫第4周起,小鼠血清中检出高水平的特异性抗体,CMR加氢氧化铝佐剂免疫小鼠的血清特异性抗体显著高于未加佐剂组。CMR在体外刺激正常小鼠和免疫小鼠脾淋巴细胞增殖水平显著高于对照组,WCV则抑制正常脾淋巴细胞增殖。三种剂量(30μg、10μg、1μg/只)CMR免疫小鼠血和脾脏样本贝氏柯克斯体含量显著低于未免疫组,以30μg组及加佐剂免疫小鼠的样本含菌量更显著低于对照组。结论采用我国分离株制备的CMR疫苗能诱导机体产生高效特异性体液免疫和细胞免疫应答,使机体抵抗大剂量的贝氏柯克斯体感染,具有良好的免疫原性和免疫保护性;氢氧化铝佐剂能显著增强CMR疫苗的免疫保护效能。     

Acute kidney injury in acute Q fever

Coxiella burnetii infection is not known to involve directly the kidneys. Kidney injury associated with Q fever usually manifests in the setting of chronic infection or endocarditis with development of immune complex deposition. Acute kidney injury (AKI) in the context of acute Q fever infection may be more pathologically heterogeneous. We describe two cases of severe AKI secondary to acute Q fever infection, each with marked differences in pathological characteristics, and clinical course.     

Clinical features of Q fever pneumonia]

We report four cases of Q fever pneumonia diagnosed using PanBio Coxilla burnetii ELISA. The patients, a 21-year-old woman, a 53-year-old man, a 74-year-old man and a 87-year-old man, were among 284 with community-acquired pneumonia who were treated as inpatients from March 2001 till March 2003. The frequency of Q fever pneumonia in community-acquired pneumonia was 1.4%. The 21-year-old woman was a typical case of Q fever pneumonia, since her clinical features showed 1. the breeding of cats, 2. development from a fever and non-productive caught in March, 3. multiple soft consolidations in the chest radiograph, 4. normal WBC count, 5. cure by administration of clarithromycin. The pneumonias of the other 3 cases were considered to be mixed infections, with bacteria such as Streptococcus pneumoniae and Haemophilus influenzae. Their clinical features were 1. elderly male patients with underlying diseases, 2. development from fever and cough with purulent sputum in winter, 3. coarse crackle on auscultation, 4. consolidation with pleural effusion in chest radiograph, 5. leukocytosis, elevation of BUN, hyponatremia, 6. a few cases with unfavorable prognoses despite medication with carbapenem and minocycline. These findings suggested that two types of pneumonia exist; one with the usual features of atypical pneumonia, and the other presenting the clinical features of bacterial pneumonia of the elderly due to a mixed infection including C. burnetti.     

Q fever endocarditis: a case report and review of the literature

The case of a 31-year-old man from Alberta diagnosed with Q fever endocarditis is presented. To the authors' knowledge, this is the first case of Q fever endocarditis diagnosed in the province of Alberta. The patient had undergone open valvulotomy for congenital aortic stenosis as an infant. He presented with congestive heart failure secondary to severe aortic regurgitation and underwent mechanical aortic valve replacement. Early failure of the mechanical prosthesis and numerous laboratory abnormalities prompted an investigation for endocarditis, which was initially negative. Markedly positive serology eventually established the diagnosis of chronic Q fever. The patient subsequently underwent a second aortic valve replacement following initiation of appropriate antimicrobials directed against Coxiella burnetii. The present report reviews the clinical presentation and diagnosis of Q fever endocarditis. It highlights the insidious and nonspecific nature of the presenting symptoms, and emphasizes the use of serology for diagnosis. Increased awareness and earlier diagnosis can significantly decrease the morbidity and mortality associated with this disease.     

Q fever in Quebec (1989�C93): Report of 14 cases

Q fever, a zoonosis acquired by inhalation of the rickettsia Coxiella burnetii, is rarely diagnosed in Canada. The world incidence has been increasing since 1960, because of progressive dissemination of this microorganism in animal populations, particularly domestic ruminants. Some recent outbreaks were caused by cats. Of 14 cases reported in Quebec between 1989 and the beginning of 1993, nine occurred successively in an 18-month period in the rural region surrounding Trois-Rivières, after contact with livestock or cats. These cases are reported here, with the results of serological screening of the workers of an abattoir where one of the cases worked. Five additional cases reported in Quebec during the same period are briefly reviewed.     

Severe acute Q fever pneumonia complicated by presumed persistent localized Q fever endocarditis in a renal transplant recipient: A case report and review of the literature

Q fever in solid organ transplant (SOT) recipients is rarely described in the medical literature. We present a case of severe acute Q fever pneumonia that evolved into persistent localized Q fever endocarditis in a renal transplant recipient.     

Unusual presentation of Q fever in a kidney‐pancreas transplant recipient

Q fever is uncommon in solid organ transplant (SOT) recipients. We describe a case of granulomatous lung disease as an unusual presentation of chronic Q fever in a kidney‐pancreas transplant recipient.