Clinical characteristics of Q fever and etiology of community-acquired pneumonia in a tropical region of southern Taiwan: a prospective observational study.

Abstract

BACKGROUND:

The clinical characteristics of Q fever are poorly identified in the tropics. Fever with pneumonia or hepatitis are the dominant presentations of acute Q fever, which exhibits geographic variability. In southern Taiwan, which is located in a tropical region, the role of Q fever in community-acquired pneumonia (CAP) has never been investigated.

METHODOLOGY/PRINCIPAL FINDINGS:

During the study period, May 2012 to April 2013, 166 cases of adult CAP and 15 cases of acute Q fever were prospectively investigated. Cultures of clinical specimens, urine antigen tests for Streptococcus pneumoniae and Legionella pneumophila, and paired serologic assessments for Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Q fever (Coxiella burnetii) were used for identifying pathogens associated with CAP. From April 2004 to April 2013 (the pre-study period), 122 cases of acute Q fever were also included retrospectively for analysis. The geographic distribution of Q fever and CAP cases was similar. Q fever cases were identified in warmer seasons and younger ages than CAP. Based on multivariate analysis, male gender, chills, thrombocytopenia, and elevated liver enzymes were independent characteristics associated with Q fever. In patients with Q fever, 95% and 13.5% of cases presented with hepatitis and pneumonia, respectively. Twelve (7.2%) cases of CAP were seropositive for C. burnetii antibodies, but none of them had acute Q fever. Among CAP cases, 22.9% had a CURB-65 score ≧2, and 45.8% had identifiable pathogens. Haemophilus parainfluenzae (14.5%), S. pneumoniae (6.6%), Pseudomonas aeruginosa (4.8%), and Klebsiella pneumoniae (3.0%) were the most common pathogens identified by cultures or urine antigen tests. Moreover, M. pneumoniae, C. pneumoniae, and co-infection with 2 pathogens accounted for 9.0%, 7.8%, and 1.8%, respectively.

CONCLUSIONS:

In southern Taiwan, Q fever is an endemic disease with hepatitis as the major presentation and is not a common etiology of CAP.

• Authors: Chung-Hsu Lai, Lin-Li Chang, Jiun-Nong Lin, Wei-Fang Chen, Yu-Feng Wei, Chien-Tung Chiu, Jiun-Ting Wu, Chi-Kuei Hsu, Jung-Yueh Chen, Ho-Sheng Lee, Hsi-Hsun Lin, Yen-Hsu Chen
• Journal: PloS one (PLoS One) Vol. 9 Issue 7 Pg. e102808 ( 2014) ISSN: 1932-6203 [Electronic] United States
• PMID: 25033402 (Publication Type: Journal Article, Observational Study, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Community-Acquired Infections (epidemiology, etiology)
• Female
• Humans
• Male
• Middle Aged
• Pneumonia (epidemiology, etiology)
• Prospective Studies
• Q Fever (epidemiology, etiology)
• Retrospective Studies
• Taiwan (epidemiology)