Kampschreur Linda M, Delsing Corine E, Groenwold Rolf H H, Wegdam-Blans Marjolijn C A, Bleeker-Rovers Chantal P, de Jager-Leclercq Monique G L, Hoepelman Andy I M, van Kasteren Marjo E, Buijs Jacqueline, Renders Nicole H M, Nabuurs-Franssen Marrigje H, Oosterheert Jan Jelrik, Wever Peter C
Division of Medicine, Department of Internal Medicine and Infectious Diseases, University Medical Centre Utrecht, Utrecht, the Netherlands.
J Clin Microbiol. 2014 May;52(5):1637-43. doi: 10.1128/JCM.03221-13. Epub 2014 Mar 5.
Coxiella burnetii causes Q fever, a zoonosis, which has acute and chronic manifestations. From 2007 to 2010, the Netherlands experienced a large Q fever outbreak, which has offered a unique opportunity to analyze chronic Q fever cases. In an observational cohort study, baseline characteristics and clinical characteristics, as well as mortality, of patients with proven, probable, or possible chronic Q fever in the Netherlands, were analyzed. In total, 284 chronic Q fever patients were identified, of which 151 (53.7%) had proven, 64 (22.5%) probable, and 69 (24.3%) possible chronic Q fever. Among proven and probable chronic Q fever patients, vascular infection focus (56.7%) was more prevalent than endocarditis (34.9%). An acute Q fever episode was recalled by 27.0% of the patients. The all-cause mortality rate was 19.1%, while the chronic Q fever-related mortality rate was 13.0%, with mortality rates of 9.3% among endocarditis patients and 18% among patients with a vascular focus of infection. Increasing age (P=0.004 and 0.010), proven chronic Q fever (P=0.020 and 0.002), vascular chronic Q fever (P=0.024 and 0.005), acute presentation with chronic Q fever (P=0.002 and P<0.001), and surgical treatment of chronic Q fever (P=0.025 and P<0.001) were significantly associated with all-cause mortality and chronic Q fever-related mortality, respectively.
伯纳特立克次体可引发Q热，这是一种人畜共患病，有急性和慢性两种表现形式。2007年至2010年期间，荷兰经历了一次大规模Q热疫情，这为分析慢性Q热病例提供了独特契机。在一项观察性队列研究中，对荷兰确诊、疑似或可能患有慢性Q热患者的基线特征、临床特征以及死亡率进行了分析。总共识别出284例慢性Q热患者，其中151例（53.7%）确诊，64例（22.5%）疑似，69例（24.3%）可能患有慢性Q热。在确诊和疑似慢性Q热患者中，血管感染病灶（56.7%）比心内膜炎（34.9%）更为常见。27.0%的患者回忆起曾有过急性Q热发作。全因死亡率为19.1%，而慢性Q热相关死亡率为13.0%，心内膜炎患者的死亡率为9.3%，血管感染病灶患者的死亡率为18%。年龄增长（P=0.004和0.010）、确诊慢性Q热（P=0.020和0.002）、血管性慢性Q热（P=0.024和0.005）、慢性Q热急性发作（P=0.002和P<0.001）以及慢性Q热的手术治疗（P=0.025和P<0.001）分别与全因死亡率和慢性Q热相关死亡率显著相关。
