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

Q fever is a zoonotic infection caused by Coxiella burnetti, which has been previously regarded as an uncommon infectious disease in Korea but is sporadically reported recently. Common manifestations of acute Q fever usually present as influenza-like illness, pneumonia and occasionally hepatitis. Herein, we report 4 cases of acute Q fever as a cause of acute hepatitis and fever. All patients had fever and non-specific symptoms, and laboratory test showed acute hepatitis. Antibody surveys for many virus infections and bacterial cultures were negative. Finally, they were diagnosed acute Q fever by an indirect microimmunofluorescence test. Liver biopsy in 3 patients revealed granuloma including one with typical fibrin-ring. All patients had complete resolution of symptoms and signs with doxycycline treatment. Q fever should be considered in the differential diagnosis of patients with fever of unknown origin with acute hepatitis in Korea.
Acute Disease ; Adult ; Anti-Bacterial Agents/therapeutic use ; Coxiella burnetii/isolation & purification ; Doxycycline/therapeutic use ; Fluorescent Antibody Technique, Indirect ; Hepatitis/*diagnosis/etiology/pathology ; Humans ; Male ; Middle Aged ; Q Fever/complications/diagnosis/drug therapy ; Rifampin/therapeutic use

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 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

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

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

BACKGROUND: Fibrin-ring granuloma (FRG), which can be found in bone marrow or the liver, is a subtype of epithelioid granuloma characterized by a central fat vacuole and annular peripheral fibrinoid materials. FRG has been proven to be associated with many etiologies such as several infectious organisms (Coxiella burnett; Epstein-Barr Virus, EBV; cytomegalovirus, CMV; and hepatitis A virus), allopurinol induced hepatitis, Hodgkin's lymphoma, and peripheral T-cell lymphoma. METHODS: We retrospectively reviewed 24 patients diagnosed with FRG by bone marrow biopsy at a single institute between 1995 and 2004. We reviewed clinical symptoms and laboratory findings of the patients, classified them by etiology, and compared prognosis of each group. RESULTS: The most common cause of FRG was acute or chronic EBV infection. Chronic or acute EBV infection was associated with 41.4% of patients (10/24). Of the remaining patients, 33.3% (8/24) were leukemia or lymphoma patients after chemotherapy, 4.2% (1/24) was a patient with hepatic failure, and 20.8% (5/24) were diagnosed as fever of unknown origin. The most common symptom and clinical finding were fever and cytopenia. EBV-associated group comprised chronic active EBV infection, EBV-associated hemophagocytic histiocytosis, acute EBV infection, EBV-associated lymphoproliferative disease, and Langerhans' cell histiocytosis. The EBV-associated group showed a lower survival probability compared with the non-EBV group (P<0.05). CONCLUSIONS: Patients with bone marrow fibrin ring granuloma accompanied by fever require an active workup to find out the cause of infectious agents including EBV infection particularly due to their poor prognosis.
Adolescent ; Adult ; Aged ; Bone Marrow Diseases/diagnosis/*etiology/pathology ; Child ; Child, Preschool ; Epstein-Barr Virus Infections/*complications/diagnosis ; Female ; Fibrin/analysis ; Granuloma/diagnosis/*etiology/pathology ; Herpesvirus 4, Human/immunology/isolation & purification ; Humans ; In Situ Hybridization ; Male ; Middle Aged ; Polymerase Chain Reaction ; Prognosis ; Q Fever/diagnosis ; Retrospective Studies ; Survival Rate

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 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