葡萄牙的急性Q热。32例住院患者的流行病学和临床特征。
Acute Q fever in Portugal. Epidemiological and clinical features of 32 hospitalized patients.
作者信息
Palmela Carolina, Badura Robert, Valadas Emília
机构信息
Faculty of Medicine, Lisbon University, Portugal;
MD, Infectious and Parasitic Diseases University Clinic, Faculty of Medicine, Santa Maria's University Hospital, Lisbon, Portugal;
出版信息
Germs. 2012 Jun 1;2(2):43-59. doi: 10.11599/germs.2012.1013.
INTRODUCTION
Q fever is a worldwide zoonosis caused by Coxiella burnetii. The main characteristic of acute Q fever is its clinical polymorphism, usually presenting as a febrile illness with varying degrees of hepatitis and/or pneumonia. Q fever is endemic in Portugal, and it is an obligatory notifiable disease since 1999. However, its epidemiological and clinical characteristics are still incompletely described.
METHODS
We performed a retrospective study of 32 cases admitted in the Infectious Diseases Department, Santa Maria's University Hospital, from January 2001 to December 2010, in whom acute Q fever was diagnosed by the presence of antibodies to phase II Coxiella burnetii antigens associated with a compatible clinical syndrome.
RESULTS
Out of the 32 cases recorded, 29 (91%) were male, with a male:female ratio of 9.7:1. Individuals at productive age were mainly affected (88%, n=28, with ages between 25 and 64 years). Clinically, the most common manifestation of acute Q fever was hepatic involvement (84%, n=27), which occurred isolated in 53% (n=17) of the cases. Hepatitis was more severe, presenting with higher values of liver function tests, in patients presenting both pulmonary and hepatic involvement. Additionally, we report one case of myocarditis and another one with neurological involvement. Empiric but appropriate antibiotic therapy was given in 66% (n=21) of the cases. There was a complete recovery in 94% (n=30) of the patients, and one death. We confirmed the sub-notification of this disease in Portugal, with only 47% (n=15) of the cases notified.
CONCLUSION
In Portugal further studies are needed to confirm our results. From the 32 cases studied, acute Q fever presented more frequently as a febrile disease with hepatic involvement affecting mainly young male individuals. Furthermore, acute Q fever is clearly underdiagnosed and underreported in Portugal, which suggests that an increased awareness of the disease is needed, together with a broader use of serological testing.
引言
Q热是一种由伯氏考克斯体引起的全球性人畜共患病。急性Q热的主要特征是其临床多态性，通常表现为伴有不同程度肝炎和/或肺炎的发热性疾病。Q热在葡萄牙呈地方性流行，自1999年起为法定报告传染病。然而，其流行病学和临床特征仍未完全阐明。
方法
我们对2001年1月至2010年12月在圣玛丽亚大学医院传染病科收治的32例患者进行了回顾性研究，这些患者因存在与相匹配临床综合征相关的抗II期伯氏考克斯体抗原抗体而被诊断为急性Q热。
结果
在记录的32例病例中，29例（91%）为男性，男女比例为9.7:1。主要受累的是处于生育年龄的个体（88%，n = 28，年龄在25至64岁之间）。临床上，急性Q热最常见的表现是肝脏受累（84%，n = 27），其中53%（n = 17）的病例为孤立性肝脏受累。在同时存在肺部和肝脏受累的患者中，肝炎更为严重，肝功能检查值更高。此外，我们报告了1例心肌炎病例和1例神经系统受累病例。66%（n = 21）的病例接受了经验性但恰当的抗生素治疗。94%（n = 30）的患者完全康复，1例死亡。我们证实了葡萄牙对该疾病的报告不足，仅47%（n = 15）的病例得到报告。
结论
在葡萄牙，需要进一步研究以证实我们的结果。在所研究的32例病例中，急性Q热更常表现为伴有肝脏受累的发热性疾病，主要影响年轻男性个体。此外，急性Q热在葡萄牙显然诊断不足且报告不足，这表明需要提高对该疾病的认识，并更广泛地应用血清学检测。
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