Chest
Volume 114, Issue 3, September 1998, Pages 808-813
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Acute Q Fever Pneumonia: A Review of 80 Hospitalized Patients

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Study objectives: To emphasize epidemiologic, clinical, or radiologic characteristics whose detection could lead to an early diagnosis and to enhance therapeutic efficacy.

Patients: Eighty hospitalized patients from 1982 to 1996.

Design: The diagnosis of Q fever infection was serologically confirmed in all the patients (phase II Coxiella burnetii antibody) using the complement fixation test and/or the indirect immunofluorescence antibody test.

Results: Patients from rural and urban areas were noted in the same proportion; however, the usual epidemiologic factors such as contact with cats or farm animals were found in 40% of the patients. Mean age ± SD was 49 ± 20 years, and there was a higher sex ratio of male to female patients (1:3.44). We found a specific seasonal distribution since 80% of the cases occurred between February and May. Delay before referring to hospital was 8.2 ± 7.8 days, while 69.3% of the patients received an antibiotic treatment that was mainly penicillin or cephalosporin. The dominant clinical features were dry cough and high fever, as the maximal temperature reached more then 40°C in 58% of the patients. Digestive symptoms were rare. WBC count remained within normal range in 80% of the cases with a low proportion of lymphocytes in half of the patients, and the sedimentation rate was usually elevated (55 ± 34 mm). Altered liver function consisted more frequently in an elevated level of alkaline phosphatase (70% of the cases) than transaminases, while hyponatremia was frequently mentioned (28.2% of the patients). We found radiologic evidence of unique lobar or segmental alveolar opacity involving more likely the lower lobes in 55 patients, and multiple or interstitial opacities in the others. Chest radiographs were considered normal in eight patients. The clinical response was favorable in all the patients with a reduction in fever 4.8 ± 3.9 days after the start of treatment with the second antibiotic that included mainly erythromycin or quinolones, and chest radiographs returned to normal in 81% of the patients within the first month.

(CHEST 1998; 114:808–813)

Section snippets

MATERIALS AND METHODS

We retrospectively studied 80 consecutive patients with Q fever pneumonia who were admitted to the Department of Pneumology and in the Department of Infectious Diseases from 1982 to 1996. The diagnosis of acute Q fever pneumonia was confirmed in all of them, excluding any epidemic situation, and in accordance with the following criteria.

RESULTS

Eighty patients (62 male and 18 female) whose mean ± SD age was 49 ± 20 years have been included in this study. Thirty-nine patients were admitted to the Department of Pneumology while 41 patients were hospitalized in the Department of Infectious Disease. A smoking habit was found in 42% of the patients, and 51% of them had no medical history. No one was known to be immunosuppressed. Thirty-five patients (43%) were characterized as having urban lifestyles and the others were characterized as

DISCUSSION

We present the results of a retrospective study whose goal was to analyze the clinical, biological, and radiologic characteristics of numerous hospitalized patients with confirmed acute Q fever pneumonia in order to attempt to point out parameters that could help diagnostic orientation and contribute to the choice of adapted therapy.

Q fever is a ubiquitous zoonose caused by the rickettsial organism C burnetii. The presence of a positive serology in asymptomatic people was found to have a varied

ACKNOWLEDGMENTS

The authors thank R. Pendergast for his collaboration and his linguistic assistance.

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    Manuscript received October 17, 1997; revision accepted March 19, 1998.

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