Department of Internal Medicine, Division of Infectious Diseases, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands; Radboud Expert Center for Q fever, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
Department of Internal Medicine, Division of Infectious Diseases, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands; Radboud Expert Center for Q fever, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
Eur J Intern Med. 2018 Aug;54:6-12. doi: 10.1016/j.ejim.2018.06.007. Epub 2018 Jun 19.
Q fever infection can lead to chronic Q fever, a potentially lethal disease occurring in 1-5% of patients infected with Coxiella burnetii, characterized by the persistence of this intracellular bacterium. It usually presents as endocarditis, infected vascular aneurysms, or infected vascular prostheses. This systematic review of the literature discusses the various autoimmune syndromes and B-cell dyscrasias in acute and chronic Q fever patients, that may interfere with or impede recognition and diagnosis of Q fever. Reportedly, high concentrations of anti-cardiolipin antibodies may be found in acute Q fever patients, while specifically cardiac muscle antibodies have been reported during chronic Q fever. Systemic lupus erythematosus and antiphospholipid syndrome are the most frequently reported autoimmune syndromes, followed by neuromuscular disorders and vasculitis. B-cell dyscrasia, mostly cryoglobulinaemia, is predominantly described in chronic Q fever patients with endocarditis. We conclude that immunological (epi)phenomena are not rare during Q fever and may obscure the infectious etiology of the disease.
Q 热感染可导致慢性 Q 热，这是一种潜在致命的疾病，发生在感染柯克斯体的患者中 1-5%，其特征是这种细胞内细菌的持续存在。它通常表现为心内膜炎、感染性血管动脉瘤或感染性血管假体。本系统综述文献讨论了急性和慢性 Q 热患者的各种自身免疫综合征和 B 细胞异常，这些可能干扰或阻碍对 Q 热的识别和诊断。据报道，急性 Q 热患者可能存在高浓度的抗心磷脂抗体，而在慢性 Q 热期间则报道了特定的心肌抗体。系统性红斑狼疮和抗磷脂综合征是最常报道的自身免疫综合征，其次是神经肌肉疾病和血管炎。B 细胞异常，主要是冷球蛋白血症，主要描述为伴有心内膜炎的慢性 Q 热患者。我们的结论是，免疫（epi）现象在 Q 热期间并不罕见，可能会掩盖疾病的感染病因。
