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KMID : 0882420100790040404
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Korean Journal of Medicine
2010 Volume.79 No. 4 p.404 ~ p.411
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Clinical characteristics of acute Q fever in Daegu area
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Lee Kyoung-Suk
Choi Young-Sil
Kwon Ki-Tae
Lee Mi-Jung
Seo A-Young
Lee Shin-Won
Han Seung-Woo
Kim Gun-Woo
Kim Hyun-Soo
Park Chang-Keun
Sohn Kyung-Rak
Kim Shin-Woo
Chang Hyun-Ha
Ryu Seong-Yeol
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Abstract
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Background/Aims: Although only a few sporadic cases of Q fever have been reported in Korea, a total of 13 cases have been seen in our area. We performed this study to evaluate the clinical characteristics of these cases of acute Q fever.
Methods: Demographic features, clinical manifestations, laboratory and radiologic findings, and therapeutic outcomes of all cases were evaluated. Q fever was diagnosed using an indirect micro-immunofluorescence assay (MIFA) and polymerase chain reaction (PCR).
Results: A total of 13 patients with acute Q fever seen from January 2006 to August 2008 at three teaching hospitals in the Daegu Metropolitan City area were enrolled. The mean age was 49 years old (range, 24~76), and the male to female ratio was 11:2. Six (46.2%) cases had a history of animal contact. Fever (100%) was the most common manifestation, followed by myalgia (84.6%), headache (61.5%), anorexia (61.5%), and chills (61.5%). All cases were diagnosed with high titers of anti-phase II antibody (IgM≥1:50, IgG≥1:200) and positive nested PCR for the 27-kDa OMP com-1 gene of Coxiella burnettii in the blood. In three cases, liver biopsies revealed the presence of compact fibrin-ring granulomas. No characteristics of pneumonia were diagnosed on chest X-rays. The predominant presentation was acute febrile illness with hepatitis, including three cases (27.3%) of severe cholestatic hepatitis. The most frequently used antimicrobial agent was doxycycline (84.6%), followed by azithromycin (7.7%).
Conclusions: Acute Q fever may be added to the list of differential diagnosis of patients with acute febrile illness and hepatitis in the Daegu Metropolitan City area.
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KEYWORD
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Hepatitis, Granuloma, Q-fever
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