Q Ateşi’nin Yeterince Farkında Mıyız? Tek Merkez Deneyimi

ÖZGİRİŞ: Q ateşi, Coxiella burnetii’nin neden olduğu bir zoonozdur. Başlıca klinik prezentasyonları pnömoni ve hepatit’tir. Bununla birlikte, birçok farklı klinik prezentasyonlar nedeniyle Q ateşini tanımak güç olabilir. Bu çalışmada, kurumumuzdaki Q ateşi olgularının klinik ve laboratuvar özelliklerini sunarak Q ateşi farkındalığını artırmayı amaçladık.GEREÇ VE YÖNTEMLER: Hastanemiz veri tabanındaki Q ateşi tanılı hastalar retrospektif olarak değerlendirilmiştir. Hastaların karakteristikleri, başvurudaki klinik ve laboratuvar değerleri kaydedilmiştir.BULGULAR: Bu çalışmaya toplam altı hasta dahil edilmiştir. En sık ateş, iştahsızlık ve bitkinlik gibi semptomlar olmak üzere çeşitli klinik prezentasyonlar gözlenmiştir. En sık laboratuvar anormalliği tüm hastalarda saptanan CRP yüksekliğiydi, LDH ve transaminaz yüksekliği bunu takip etmekteydi. Gerek LDH yüksekliği gerekse transaminaz yüksekliği dört hastada mevcuttu.SONUÇ: Q ateşini teşhis etmek için kullanılan serolojik yöntemler rutin olarak uygulanmamaktadır, bu yüzden Q ateşi olguları kolayca gözden kaçabilir. Biz inanıyoruz ki, endemik bölgelerde nonspesifik antibiyotik tedavisine yeterli yanıt vermeyen hastalarda Q ateşi daha çok araştırılmalıdır

Are We Aware of Q Fever Enough? Experience From A Single Centre

ABSTRACTBACKGROUND: Q fever is a zoonosis caused by Coxiella burnetii. The main clinical presentations are pneumonia and hepatitis. However, it can be difficult torecognise Q fever due to many different clinical presentations. In this study, we aimed to increase the awareness of Q fever by presenting clinical and laboratory features of Q fever cases from our institution.MATERIAL and METHODS: Patients with a diagnosis of Q fever in our hospital database were evaluated retrospectively. Patient characteristics as well asclinical and laboratory values at presentation were recorded.RESULTS: A total of six patients were included in this study. Various clinical presentation was observed such as fever, anorexia and malaise as the most commonsymptoms. The most common laboratory abnormality was CRP elevation as being detected in all patients followed by LDH and transaminase elevations. bothwere found in four patients.CONCLUSION: Serological methods used to diagnose Q fever are not routinely performed, so Q fever cases can be missed easily. We believe that Q fever should beinvestigated further in patients from endemic regions who did not give adequate response to nonspesific antibiotic treatment.

PDF

___

1. Parker NR, Barralet JH, Bell AM. Q fever. Lancet 2006; 367(9511):679-88.
2. Tissot-Dupont H, Raoult D: Q fever. Infect Dis Clin North Am 2008;22: 505-14.
3. Hartzell JD, Wood‑Morris RN, Martinez LJ, Trotta RF. Q fever: Epidemiology, diagnosis, and treatment. Mayo Clin Proc 2008; 83:574‑9.
4. Marrie TJ. Q fever, In: Tropical Infectious Diseases: Principles, Pathogens and Practice, 2nd ed. (Guerrant RL, editor) 2006, pp 574‑577. Elsevier Churchill Livingstone, Philadelphia.
5. Gozalan A, Rolain JM, Ertek M, et al. Seroprevalence of Q fever in a district located in the west Black Sea region of Turkey. Eur J Clin Microbiol Infect Dis 2010;29:465-9.
6. Kennerman E, Rousset E, Gölcü E, Dufour P. Seroprevalence of Q fever (coxiellosis) in sheep from the Southern Marmara Region, Turkey. Comp Immunol Microbiol Infect Dis 2010;33:37-45.
7. Cikman A, Aydin M, Gulhan B, et al. The seroprevalence of Coxiella burnetii in Erzincan, Turkey: Identification of the risk factors and their relationship with geographical features. J Vector Borne Dis 2017;54:157-63.
8. Ergönül O, Zeller H, Kiliç S, et al. Zoonotic infections among veterinarians in Turkey: CrimeanCongo hemorrhagic fever and beyond. Int J Infect Dis 2006;10:465-9.
9. Berktaş M, Ceylan E, Yaman G, Çiftci İH. Seroprevalence of Coxiella burnetii antibodies in high risk groups in eastern Turkey. Turkiye Klinikleri Journal of Medical Sciences 2011;31:45- 50.
10. Kılıç S, Aslantaş Ö, Çelebi B, Pınar D, Babür C. Investigation of seroprevalences of Q fever, Brucellosis and Toxoplasmosis in risk groups in Hatay. Turkish Bulletin of Hygiene and Experimental Biology 2007;64:16-21.
11. Gikas A, Kokkini S, Tsioutis C. Q fever: clinical manifestations and treatment. Expert Rev Anti Infect Ther 2010;8:529–39.
12. Marrie TJ, Raoult D: Q fever–a review and issues for the next century. Int J Antimicrob Agents 1997;8:145-61.
13. Vanderbeke L, Peetermans WE, Saegeman V, De Munter P. Q fever: a contemporary case series from a Belgian hospital. Acta Clin Belg 2016;27:1- 7.
14. Karabay O, Kocoğlu E, Baysoy G, Konyalioğlu S. Coxiella burnetii seroprevalence in the rural part of Bolu, Turkey. Turk J Med Sci 2009;39:641-5.
15. Maurin M, Raoult D. Q fever. Clin Microbiol Rev 1999;12:518‑53.
16. Leone M, Honstettre A, Lepidi H, Capo C, Bavard F, Raoult D. Effect of sex on Coxiella burnetii infection: protective role of 17 betaestradiol. J Infect Dis 2004;189:339-45.
17. Raoult D, Marrie T, Mege J. Natural history and pathophysiology of Q fever. Lancet Infect Dis 2005;5:219–26.
18. Alves J, Almeida F, Duro R, et al. Presentation and diagnosis of acute Q fever in Portugal - A case series. IDCases 2016;7:34-7.
19. Marrie T.J. Q fever pneumonia. Curr Opin Infect Dis 2004;17:137–42.
20. Fournier PE, Marrie TJ, Raoult D. Diagnosis of Q fever. J Clin Microbiol 1998;36:1823-34.
21. Yeşilyurt M, Kılıç S, Gürsoy B, Celebi B, Yerer M. Two cases of acute hepatitis associated with Q fever. Mikrobiyol Bul 2012; 46:480-7.
22. Kose H, Temocin F, Sari T. Atypical Acute Q Fever: A Case Report. Klimik Journal 2017;30:38- 40.
23. Yıldırmak T, Şimşek F, Çelebi B, Çavuş E, Kantürk A, Efe-İris N. A Rare Case of Acute Q Fever Presenting with Deep Jaundice and a Review of the Literature. Klimik Journal 2010;23:124-9.
24. Korkmaz S, Elaldi N, Kayatas M, Sencan M, Yildiz E. Unusual manifestations of acute Q fever: autoimmune hemolytic anemia and tubulointerstitial nephritis. Ann Clin Microbiol Antimicrob 2012;11:14.
25. Karabay O, Gozdas HT, Ozturk G, Tuna N, Utku AC. A Q fever case mimicking crimean-congo haemorrhagic fever. Indian J Med Microbiol 2011;29:418-9.
26. Yılmaz G, Öztürk B, Memikoğlu O, et al. An Unusual Manifestation of Q Fever: Peritonitis. J Infect Public Health 2015;8:373-6.
27. Şimşek Yavuz S, Özbek E, Başaran S, et al. The first case of chronic Q fever endocarditis and aortitis from Turkey: A 5-year infection before diagnosis with drain in sternum. Anatol J Cardiol 2016;16:814-6.