Q fever is an important zoonosis caused by the rickrttsial organism, Coxiella burnetii. It is a very contagious organism which humans can contact by inhaling aerosolized organisms. Most commonly it leads to an acute flu-like illness. The diagnosis is usually confirmed serologically using a complement fixation or microimmunofluorescence test. Previous reports suggest that case-to-case in men is rare. We report person-to-person transmission, within a familly and doctors who participated in the care of the C. burnetii-infected the patient Q fever is possibly underdiagnosed in children, it should be considered in children with fever of unknown origin.
Child ; Complement System Proteins ; Coxiella burnetii ; Diagnosis ; Fever of Unknown Origin ; Humans ; Inhalation ; Multiple Endocrine Neoplasia Type 1 ; Q Fever*

Q fever is a zoonotic infection caused by Coxiella burnetii. Acute Q fever usually develops as a self-limited flu-like illness, atypical pneumonia, or hepatitis. We experienced a case of Q fever in a 50-year-old male who had a prolonged fever. The bone marrow and lymph node biopsy revealed fibrin-ring granulomas, which is a distinct finding of Q fever. The diagnosis was proven by high titers of C. burnetii anti-phase II antibody (IgM 1:512 and IgG >,048) and positive nested PCR for the com-1 gene. Q fever is rare in Korea, but should be considered in the differential diagnosis of fever of unknown origin
Biopsy ; Bone Marrow ; Coxiella burnetii ; Diagnosis, Differential ; Fever ; Fever of Unknown Origin ; Granuloma ; Hepatitis ; Humans ; Immunoglobulin G ; Korea ; Lymph Nodes ; Male ; Middle Aged ; Pneumonia ; Polymerase Chain Reaction ; Q Fever

Although Q fever is an important zoonotic infection with a worldwide distribution, no human isolates of Coxiella burnetii have been identified in Korea. For the first time, we identified the nucleotide sequence of C. burnetii from a 32-year-old man with an acute febrile illness in Korea. Diagnosis of acute Q fever was confirmed by seroconversion using indirect immunofluorescence antibody assays. Phylogenetic analysis demonstrated high sequence similarity (99.6%–100%) with C. burnetii 16S rRNA sequences identified from the reservoir. These results are the first genetic analysis of C. burnetii in a human case of Q fever in Korea.
Adult ; Base Sequence ; Coxiella burnetii* ; Coxiella* ; Diagnosis ; Fluorescent Antibody Technique, Indirect ; Humans ; Korea* ; Q Fever ; Seroconversion ; Zoonoses

BACKGROUND/AIMS: Although only a few sporadic cases of Q fever have been reported in Korea, a total of 13 cases have been seen in our area. We performed this study to evaluate the clinical characteristics of these cases of acute Q fever. METHODS: Demographic features, clinical manifestations, laboratory and radiologic findings, and therapeutic outcomes of all cases were evaluated. Q fever was diagnosed using an indirect micro-immunofluorescence assay (MIFA) and polymerase chain reaction (PCR). RESULTS: A total of 13 patients with acute Q fever seen from January 2006 to August 2008 at three teaching hospitals in the Daegu Metropolitan City area were enrolled. The mean age was 49 years old (range, 24~76), and the male to female ratio was 11:2. Six (46.2%) cases had a history of animal contact. Fever (100%) was the most common manifestation, followed by myalgia (84.6%), headache (61.5%), anorexia (61.5%), and chills (61.5%). All cases were diagnosed with high titers of anti-phase II antibody (IgM> or = 1:50, IgG> or =1:200) and positive nested PCR for the 27-kDa OMP com-1 gene of Coxiella burnettii in the blood. In three cases, liver biopsies revealed the presence of compact fibrin-ring granulomas. No characteristics of pneumonia were diagnosed on chest X-rays. The predominant presentation was acute febrile illness with hepatitis, including three cases (27.3%) of severe cholestatic hepatitis. The most frequently used antimicrobial agent was doxycycline (84.6%), followed by azithromycin (7.7%). CONCLUSIONS: Acute Q fever may be added to the list of differential diagnosis of patients with acute febrile illness and hepatitis in the Daegu Metropolitan City area.
Animals ; Anorexia ; Azithromycin ; Biopsy ; Chills ; Coxiella ; Diagnosis, Differential ; Doxycycline ; Female ; Fever ; Granuloma ; Headache ; Hepatitis ; Hospitals, Teaching ; Humans ; Korea ; Liver ; Male ; Pneumonia ; Polymerase Chain Reaction ; Q Fever ; Thorax

Q fever is a zoonosis caused by Coxiella burnetii, presenting as acute and chronic illness and it has been reported worldwide. Acute Q fever is usually asymptomatic or mild and self-limiting, but infective endocarditis is one of the most serious complications of chronic Q fever and can be fatal. Known risk factors for Q fever endocarditis are valvular heart disease, immunocompromised hosts, and pregnancy. There have been some reports on Q fever in Korea but there exists no report on Q fever endocarditis. We have experienced 2 cases of Q fever with underlying valvular heart disease; both patients came to the hospital for evaluation of prolonged fever. Although Q fever and Q fever endocarditis are rare in Korea, Q fever endocarditis should be considered in the differential diagnosis of patient with infective endocarditis when causative microorganism cannot be identified.
Chronic Disease ; Coxiella burnetii ; Diagnosis, Differential ; Endocarditis ; Fever ; Heart ; Heart Valve Diseases ; Humans ; Immunocompromised Host ; Korea ; Porphyrins ; Pregnancy ; Q Fever ; Risk Factors

Q fever is a zoonosis caused by Coxiella burnetii, presenting as acute and chronic illness and it has been reported worldwide. Acute Q fever is usually asymptomatic or mild and self-limiting, but infective endocarditis is one of the most serious complications of chronic Q fever and can be fatal. Known risk factors for Q fever endocarditis are valvular heart disease, immunocompromised hosts, and pregnancy. There have been some reports on Q fever in Korea but there exists no report on Q fever endocarditis. We have experienced 2 cases of Q fever with underlying valvular heart disease; both patients came to the hospital for evaluation of prolonged fever. Although Q fever and Q fever endocarditis are rare in Korea, Q fever endocarditis should be considered in the differential diagnosis of patient with infective endocarditis when causative microorganism cannot be identified.
Chronic Disease ; Coxiella burnetii ; Diagnosis, Differential ; Endocarditis ; Fever ; Heart ; Heart Valve Diseases ; Humans ; Immunocompromised Host ; Korea ; Porphyrins ; Pregnancy ; Q Fever ; Risk Factors

Aged ; Cysts ; etiology ; Diagnosis, Differential ; Endocarditis, Bacterial ; complications ; diagnosis ; Humans ; Liver Diseases ; etiology ; Lung Diseases ; etiology ; Male ; Q Fever ; complications ; diagnosis

Coxiella burnetii is the etiological agent of Q fever, that may occur either acutely or the chronically. To understand the seroepidemiological patterns of C. burnetii infection in Korea, we examined a total of 3,178 sera from patients with acute febrile episodes by using indirect immunofluorescence assay (IFA) for detectable antibodies to C. burnetii and other eight rickettsial antigens. The IFA seropositivity>or=1:20 for C. burnetii phase II was 11.5% (368 out of 3,178 sera). The co-existence of antibodies to other rickettsial antigens was found in 216 out of the 368 positive sera. Thirty-seven point five percent (n=138) had antibodies to R. tsutsugamushi (cutoff>or=1:20), 16% (n=59) to Ehrlichia sennetsu, 14.9% (n=55) to Rickettsia typhi, 13.5% (n=50) to R. akari, 11.4% (n=42) to R. japonica, 8.9% (n=33) to R. prowazekii, 7.6% (n=28) to R. sibirica, and 6.7% (n=25) to R. conorii by IFA, respectively. These results are consistent with previous reports documenting diverse serum cross-reactivity in chronic Q fever. Therefore we excluded the samples that reacted to other rickettsial antigens at same or higher titers than to C. burnetii, resulting in the seropositive rate of 4.1%. The serological prevalence was 2% (n=64) when the conventional cut-off titer of 1:80 was used. Our results suggest that infections with C. burnetii are more prevalent than expected previously and should be differentially diagnosised for febrile illness occurring after exposure to ticks or other vectors.
Antibodies ; Coxiella burnetii* ; Coxiella* ; Diagnosis ; Fluorescent Antibody Technique, Indirect ; Humans ; Korea ; Neorickettsia sennetsu ; Prevalence ; Q Fever ; Rickettsia ; Rickettsia typhi ; Seroepidemiologic Studies* ; Ticks

Q fever is an orthozoonotic infection caused by Coxiella burnetii, which was recently reclassified from the order Rickettsials to the order Legionellales. Although Q fever is usually mild and self-limiting, it may be manifested as a serious disease, such as pneumonia, endocarditis, or meningoencephalitis. We describe three separate cases of acute Q fever, which were diagnosed by an indirect micro-immunofluorescence assay (MIFA) test and DNA amplification (PCR). Three adult patients were admitted between December 2004 and August 2006 because of a fever of greater than three weeks duration. Only one patient had contact history with a dog. Of the three patients, two patients had myalgia, headache, skin rash, lymphadenopathy, and hepatosplenomegaly. Although all sets of blood cultures were negative, anti-phase II antibody titers by using an indirect MIFA (IgG 1:512 - 1,024 and IgM 1:320) were markedly increased in sera from all of three patients. Concomitant PCR assays also demonstrated the presence of OMP com1 for C. burnetii in blood from all of the three patients. Two patients had complete resolution of symptoms and signs with a two week course of doxycycline, while one patient had spontaneous defervescence. Although the incidence of Q fever is not well known yet in Korea, it should be considered in the differential diagnosis of patients with fever of unknown origin.
Adult ; Animals ; Coxiella burnetii ; Diagnosis, Differential ; DNA ; Dogs ; Doxycycline ; Endocarditis ; Exanthema ; Fever ; Fever of Unknown Origin ; Headache ; Humans ; Immunoglobulin M ; Incidence ; Korea ; Lymphatic Diseases ; Meningoencephalitis ; Pneumonia ; Polymerase Chain Reaction ; Q Fever

Coxiella burnetii is the causative agent of Q fever worldwide in human and animals. While several clinical cases of Q fever were reported in Korea till the middle of 1990s, nobody has reported a case thereafter. However possibilities for an outbreak have still been raised. In this study, antibody titers to C. burnetii in patients with unknown fever and atypical pneumonia were tested by an indirect immunofluorescence method using the phase II antigen. In addition, the validity of a PCR method in indentifying C. burnetii directly from human sera was tested. Among the 560 specimens from atypical pneumonia patients, 23 sera (4.29%) reacted positively to the phase II antigen of C. burnetii. IgG antiphase II antigen titers were 1:16 in 16, 1:32 in 2, 1:64 in 2, 1:128 in 2, and > or =1:256 in one serum. IgM and IgA antibodies anti-phase II antigen were detected in 6 and 3 sera at 1:16, respectively. And each two sera had IgM antibodies at 1:32 and 1:64. Anti-phase II antigen IgG antibody titers in the patients with unknown fever were 1:16 in 5, 1:32 in 2, 1:128 in 1, and 1:256 in 3 sera. However, IgM antibody wasn't detected in this group. Of the 202 sera from abattoir workers, 5 (2.47%) reacted with phase II antigen. Among 448 sera of healthy controls, anti-phase II antigen IgG titer of 1:16 was found in 7 and 1:32 in 1 and 1:64 in 3 sera. In the case of IgM titer, two sera were reactive at 1:16 and 1:32, each. Significant differences among the test groups were not noted in the present study. The PCR assay to detect C. burnetii com-1 and plasmid genes did not show reliable specificity and sensitivity for the diagnosis of Q fever. So, the usefulness of the PCR for laboratory diagnosis of Q fever still remains controversial.
Abattoirs ; Animals ; Antibodies* ; Clinical Laboratory Techniques ; Coxiella burnetii* ; Coxiella* ; Diagnosis ; Fever* ; Fluorescent Antibody Technique, Indirect ; Humans ; Immunoglobulin A ; Immunoglobulin G ; Immunoglobulin M ; Korea ; Plasmids ; Pneumonia* ; Polymerase Chain Reaction ; Q Fever ; Sensitivity and Specificity