Immunological arousal during acute Q fever infection |
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Authors: | M Vardi N Petersil A Keysary S Rzotkiewicz A Laor and H Bitterman |
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Institution: | (1) Department of Medicine, Internal Medicine Division, Carmel Medical Center, 7 Michal Street, Haifa, 34362, Israel;(2) The Ruth and Bruce Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa, Israel;(3) Israel National Reference Center for Rickettsioses, Department of Infectious Diseases, Israel Institute for Biological Research, Ness Ziona, Israel |
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Abstract: | Physicians often encounter patients who present with a vague clinical syndrome. A wide serological workup is often ordered,
which may include tests for Coxiella burnetii in endemic areas. Often, the results of these tests pose new dilemma, with overlapping positive laboratory assays. The objective
of this investigation was to characterise the serological overlap between acute Q fever and other infectious and immunological
diseases. We retrospectively scanned the files of patients with a positive or equivocal immunoglobulin (Ig) M for C. burnetii phase II over a period of 8 years in a general hospital. Clinical and laboratory data, including antibodies to infectious
agents and antibodies related to immunological states, were recorded. Anti-nuclear antibody (ANA), smooth muscle antibody
(SMA) and rheumatoid factor were positive in 38%, 33.3% and 22.2% of the cases, respectively. In patients with acute Q fever,
elevated IgM levels for Epstein–Barr Virus (EBV), cytomegalovirus (CMV), Mycoplasma pneumoniae, parvovirus, Bordetella pertussis, Rickettsia conorii and R. typhi were noted in 13.8%, 8.3%, 12.12%, 22.2%, 25%, 13% and 21.7% of cases, respectively. Acute Q fever induces a non-specific
immunological arousal in a significant number of patients. This may interfere with diagnosis and delay treatment. Caution,
clinical judgment and serological follow-up is warranted in such conditions. |
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