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• W1524457680 abstract "We report a 2-year (2004–2005) prospective study of the incidence, epidemiology and clinical manifestations of Q fever among patients in northern Greece. Serum samples from 850 patients suspected to be infected by C. burnetii were examined for the presence of antibodies against phase I and II of the microorganism. The study population was composed of people 1–70 years old, living in the rural and urban areas of the 16 prefectures in northern Greece. Characteristics of the patients were collected, including age, sex, underlying disease, occupation, contact with animals, and consumption of unpasteurised products. One serum sample was obtained at the time of admission and a second one 4 weeks later. All sera were examined using the IFA test (Focus) and the ELISA assay (Serion) according to the manufacturer's instructions. The samples found to be positive to C. burnetii were also examined for Legionella pneumophila, Bartonella and Chlamydia species in order to exclude cross-reactivity. Acute Q fever was diagnosed in 57 (6%) patients, based on the detection of IgM antibodies 1–2 weeks after the onset of the symptoms. Seroconversion was considered to be diagnostic of Q fever and was determined in almost all cases. One chronic case, an endocarditis fulfilling the Duke criteria, was detected (Table 1).TABLE 1Clinical manifestations of Q feverManifestationNo. of patients with Q fever (n = 58)No. of tested patients (n = 980)Pneumonia28444Flu-like syndrome15228Hepatitis776Lymphadenopathy2118Pericarditis229Guillain-Barre136Osteomyelitis13Optic neuritis115Endocarditis131 Open table in a new tab Most cases, 76%, were diagnosed from January through to May. The male to female ratio was 2:1. The mean age of the patients was 45 ± 5 years. No acute or chronic form of the infection was detected in patients younger than 17 years of age. Acute Q fever was diagnosed in none of the 182 patients younger than 14 years of age, in 3.1% of patients between 15 and 29 years of age, in 8.4% of patients between 30 and 50 years of age, in 9.3% of patients aged between 50 and 70, and in 5.2% of patients older than 70 years of age. The mean time from the onset of symptoms to admission was 8 days. One patient had a history of valvulopathy and three had a history of immunodeficiency. Forty patients (69%) had a history of contact with animals, mainly with sheep. Forty-three patients (74.2%) lived in rural areas and 15 (25.8%) patients in urban areas. Seven patients had consumed unpasteurised products. Most patients were treated with doxycycline or tetracycline and recovered completely. Only two patients, who were significantly older and more immunocompromised, died eventually. Although described years ago, Q fever is still a poorly understood disease [1Raoult D Q fever: still a query after all these years.J Med Microbiol. 1996; 44: 77-78Crossref PubMed Scopus (37) Google Scholar]. The main characteristic is its clinical polymorphism. Following primary infection half of the patients remain asymptomatic [2Maurin M Rault D Q fever.Clin Microbiol Rev. 1999; 12: 518-553PubMed Google Scholar]. Among those who are symptomatic, acute Q fever typically presents as a self-limited febrile illness, pneumonia or hepatitis. Over recent years rare clinical manifestations such as osteomyelitis, optic neuritis, pericarditis, lymphathenopathy and Guillain-Barre have increasingly been reported. Endocarditis is the predominant form of chronic Q fever and mostly affects patients with underlying valvulopathy [2Maurin M Rault D Q fever.Clin Microbiol Rev. 1999; 12: 518-553PubMed Google Scholar]. Our study was undertaken in rural and urban areas to investigate the incidence and epidemiological and clinical aspects of Q fever. Diagnosis was based upon serology, with phase I and phase II antibodies distinguishing acute from chronic disease. The predominant clinical manifestations were pneumonia, flu-like syndrome and hepatitis, whereas lymphadenopathy, pericarditis, Guillain-Barre, osteomyelitis and optic neuritis were the dominant features in only a minority of patients. Endocarditis was the only chronic case. Q fever in children was not reported. Individuals aged between 30 and 50 years appeared to have an increased risk of infection. This age-related increase of the incidence and severity of infection is also evident in other surveys and may be attributed to more frequent exposure to farm animals and pets, through travel to the countryside and involvement in outdoor activities. Most cases occurred during winter and spring. Lambing occurs during winter and early spring and may explain the increased incidences during that time. Contact with animals and consumption of unpasteurised products were found to be risk factors in the acquisition of Q fever [3Langley JM Marrie TJ Leblanc JC Almudevar A Resch L Raoult D Coxiella burnetii seropositivity in parturient women is associated with adverse pregnancy outcomes.Am J Obstet Gynecol. 2003; 189: 228-232Abstract Full Text Full Text PDF PubMed Scopus (56) Google Scholar]. It is common in urban areas of Greece, even nowadays, that unpasteurised milk and cheese are distributed directly from stock-breeders and farmers to consumers. Men and women were not equally represented (2:1) and this could be explained by the fact that men are more involved in farming [2Maurin M Rault D Q fever.Clin Microbiol Rev. 1999; 12: 518-553PubMed Google Scholar]. It is also possible that female hormones may have a protective role [4Leone M Honstettre A Lepidi H Capo C Bayard F Raoult D Mege JL Gender effect on Coxiella burnetii infection: protective role of 17-beta-oestradiol.J Infect Dis. 2004; 189: 339-345Crossref PubMed Scopus (120) Google Scholar]. Almost all patients were treated with the reference standard for treatment (doxycycline or tetracycline) and recovered completely. Q fever in northern Greece has been reported in the past. In 1946, Caminopetros detected the microorganism in sera of German soldiers. Since then surveys from Crete [5Tselentis Y Gikas A Kofteridis D et al.Q fever in the Greek Island of Crete: epidemiologic, clinical, and therapeutic data from 98 cases.Clin Infect Dis. 1995; 20: 1311-1316Crossref PubMed Scopus (61) Google Scholar] and northern Greece have reported epidemiological, clinical and therapeutic data of Q fever. Reports from France, Spain and Italy indicate that epidemiological and clinical features of the disease may vary from one area of south Europe to another. In north Europe Q fever is less frequently reported and is not included in the list of nationally notifiable diseases. Our data indicate that Q fever should be considered a public health problem with several clinical manifestations and we recommend that patients with epidemiological risk factors for infection with C. burnetii should undergo serological testing for Q fever." @default.
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• W1524457680 title "Q fever in northern Greece: epidemiological and clinical data from 58 acute and chronic cases" @default.
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