Infectious and Tropical Diseases Department, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana.
Equipe EA 3593, Ecosystèmes Amazoniens et Pathologie Tropicale, Université de la Guyane, Cayenne, Guyane française.
Am J Trop Med Hyg. 2022 Aug 17;107(2):407-415. doi: 10.4269/ajtmh.21-0711.
In French Guiana, community-acquired pneumonia (CAP) represents over 90% of Coxiella burnetii acute infections. Between 2004 and 2007, we reported that C. burnetii was responsible for 24.4% of the 131 CAP hospitalized in Cayenne. The main objective of the present study was to determine whether the prevalence of Q fever pneumonia remained at such high levels. The secondary objectives were to identify new clinical characteristics and risk factors for C. burnetii pneumonia. A retrospective case-control study was conducted on patients admitted in Cayenne Hospital, between 2009 and 2012. All patients with CAP were included. The diagnosis of acute Q fever relied on titers of phase II IgG ≥ 200 and/or IgM ≥ 50 or seroconversion between two serum samples. Patients with Q fever were compared with patients with non-C. burnetii CAP in bivariate and multivariate analyses. During the 5-year study, 275 patients with CAP were included. The etiology of CAP was identified in 54% of the patients. C. burnetii represented 38.5% (106/275; 95% CI: 31.2-45.9%). In multivariate analysis, living in Cayenne area, being aged 30-60 years, C-reactive protein (CRP) > 185 mg/L, and leukocyte count < 10 G/L were independently associated with Q fever. The prevalence of Q fever among CAP increased to 38.5%. This is the highest prevalence ever reported in the world. This high prevalence justifies the systematic use of doxycycline in addition to antipneumococcal antibiotic regimens.
在法属圭亚那，社区获得性肺炎（CAP）占柯克斯体急性感染的 90%以上。2004 年至 2007 年期间，我们报道过在卡宴因 CAP 住院的 131 例患者中，有 24.4%是由贝氏柯克斯体引起的。本研究的主要目的是确定 Q 热肺炎的患病率是否仍保持在如此高的水平。次要目标是确定新的临床特征和贝氏柯克斯体肺炎的危险因素。本研究采用回顾性病例对照研究，纳入 2009 年至 2012 年在卡宴医院住院的 CAP 患者。所有 CAP 患者均纳入研究。急性 Q 热的诊断依赖于 II 期 IgG 滴度≥200 和/或 IgM≥50，或两种血清样本之间的血清学转换。采用单变量和多变量分析比较 Q 热患者和非贝氏柯克斯体 CAP 患者。在 5 年的研究期间，共纳入 275 例 CAP 患者。54%的患者确定了 CAP 的病因。在 275 例患者中，贝氏柯克斯体占 38.5%（106/275；95%可信区间：31.2-45.9%）。多变量分析显示，居住在卡宴地区、年龄在 30-60 岁、C 反应蛋白（CRP）＞185mg/L、白细胞计数＜10G/L 与 Q 热独立相关。CAP 中 Q 热的患病率上升至 38.5%。这是全球报道的最高患病率。如此高的患病率证明了在抗肺炎球菌抗生素方案之外，有必要系统地使用多西环素。
