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Q fever in Plymouth, 1972–88: A review with particular reference to neurological manifestations

Published online by Cambridge University Press:  15 May 2009

S. Reilly ,
J. L. Northwood  and
E. O. Caul
S. Reilly
Affiliation:
Department of Microbiology and Public Health Laboratory, Derriford Hospital, Plymouth PL6 SDH
J. L. Northwood
Affiliation:
Department of Microbiology and Public Health Laboratory, Derriford Hospital, Plymouth PL6 SDH
E. O. Caul
Affiliation:
Regional Department of Virology and Public Health Laboratory, Myrtle Road, Kingsdown, Bristol, BS2 8EL
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Summary

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Between 1972 and 1988 we have serologically confirmed 103 Coxiella burnetii infections: 46 were acute, 5 were chronic, 52 represented past infections. Details of 61 cases are presented.

Of acute cases 80 % had respiratory involvement; at least 63 % had pneumonias. The incidence (22%) of neurological complications was of particular interest; 40% of these patients had prolonged sequelae. One acutely ill patient died of fulminating hepatitis. Patients with pre-existing pathology or immunosuppression were especially susceptible to C. burnetii.

In the absence of acute sera, the complement fixation test alone provided inadequate differentiation between recent and past Q fever: phase II titres persisted at ⋝ 80 for more than 1 year after the acute infection in 15 cases; maximum duration of persistence was 14 years. Three patients acquired high phase I titres.

Only 5% of cases had chronic Q fever, but in view of the diverse sequelae observed in this series, we suggest that long-term serological and clinical follow-up of all cases of Q fever is fully justified.

Type
Research Article
Information
Epidemiology & Infection , Volume 105 , Issue 2 , October 1990 , pp. 391 - 408
Copyright
Copyright © Cambridge University Press 1990

References

REFERENCES

1.Marmion, BP, Stoker, MGP. Q fever in Great Britain: epidemiology of an outbreak. Lancet 1950; ii: 611–6.CrossRefGoogle Scholar
2.Hart, RJC. The epidemiology of Q fever. Postgrad Med J 1973; 49: 535–8.CrossRefGoogle ScholarPubMed
3. Anonymous. Coxiella burnetii surveillance: 1975–87. Communicable Disease Report 1988; 88/33.Google Scholar
4.Holland, WW, Rowson, KEK, Taylor, CED, Allen, AB, Ffrench-Constant, M, Smelt, CMC. Q fever in the R.A.F. in Great Britain in 1958. Br Med J 1960; 1: 387–90.CrossRefGoogle ScholarPubMed
5.Sheridan, P, MacCaig, JN, Hart, RJC. Myocarditis complicating Q fever. Br Med J 1974; 2: 155–6.CrossRefGoogle ScholarPubMed
6.Hall, CJ, Richmond, SJ, Caul, EO, Pearce, NH, Silver, IA. Laboratory outbreak of Q fever acquired from sheep. Lancet 1982; i: 1004–6.CrossRefGoogle Scholar
7.Jorm, LR, Lightfoot, NF, Morgan, KL. An epidemiological study of an outbreak of Q fever in a secondary school. Epidemiol Infect 1990; 104: 467–77.CrossRefGoogle Scholar
8.Report from five laboratories of the Public Health Laboratory Service. The occurrence of Coxiella burnetii in North-Western England and North Wales. J Hyg 1969; 67: 125–33.Google Scholar
9.Wolf, H, Kaiser, G, Gruss, JD. Q Fieber und seine Komplikationen. Dtsch Med Wochenschr 1976; 101: 173–5.Google Scholar
10.D'Angelo, LJ, Hetherington, R. Q fever treated with erythromycin. Br Med J 1979; 2: 305–6.CrossRefGoogle ScholarPubMed
11.Hillary, IB, Dooley, S, Meenan, PN. Q fever in the Republic of Ireland: an update. Ir J Med Sci 1980; 149: 59–62.CrossRefGoogle ScholarPubMed
12.Kosatsky, T. Household outbreak of Q fever pneumonia related to a parturient cat. Lancet 1984; ii: 1447–9.CrossRefGoogle Scholar
13.Marrie, TJ, Langille, D, Papukna, V, Yates, L. Truckin' pneumonia-an outbreak of Q fever in a truck repair plant probably due to aerosols from clothing contaminated by contact with newborn kittens. Epidemiol Infect 1989; 102: 119–27.CrossRefGoogle Scholar
14.Marmion, BP, Stoker, MGP. The epidemiology of Q fever in Great Britain: an analysis of the findings and some conclusions. Br Med J 1958; 2: 809–16.CrossRefGoogle ScholarPubMed
15.Wallace, SJ, Zealley, H. Neurological, electroencephalographic and virological findings in febrile children. Arch Dis Child 1970; 45: 611–23.CrossRefGoogle Scholar
16.Derrick, EH. The course of infection with Coxiella burnetii. Med J Aust 1973; 1: 1051–7.Google Scholar
17.Jones, RWA, Pitcher, DW. Q fever endocarditis in a 6 year-old child. Arch Dis Child 1980; 55: 312–5.Google Scholar
18.Sawyer, LA, Fishbein, DB, McDade, JE. Q fever: current concepts. Rev Infect Dis 1987; 9: 935–46.CrossRefGoogle ScholarPubMed
19.Heard, SR, Ronalds, CJ, Heath, RB. Coxiella burnetii infection in immunocompromised patients. J Infect 1985; 11: 15–8.CrossRefGoogle ScholarPubMed
20.Loudon, MM, Thompson, EN. Severe combined immunodeficiency syndrome, tissue transplant, leukaemia and Q fever. Arch Dis Child 1988; 63: 207–9.CrossRefGoogle ScholarPubMed
21.Weir, WRC, Bannister, B, Chambers, S, De Cock, K, Mistry, H. Chronic Q fever associated with granulomatous hepatitis. J Infect 1984; 8: 56–60.Google Scholar
22.Derrick, EH. Q fever, a new fever entity: clinical features, diagnosis and laboratory investigation. Med J Aust 1937; 2: 281–99. Reproduced in Rev Infect Dis 1983; 5: 790–800.CrossRefGoogle Scholar
23.Clark, WH, Lennette, EH, Railsback, OC, Romer, MS. Q fever in California. VII. Clinical features in one hundred eighty cases. Arch Intern Med 1951; 88: 155–67.CrossRefGoogle ScholarPubMed
24.Powell, O. Q fever: clinical features in 72 cases. Aust Ann Med 1960; 9: 214–23.Google Scholar
25.Dupont, HL, Hornick, RB, Levin, HS, Rapoport, MI, Woodward, TE. Q fever hepatitis. Ann Intern Med 1971; 74: 198–206.CrossRefGoogle ScholarPubMed
26.Spelman, DW. Q fever: a study of 111 consecutive cases. Med J Aust 1982; 1: 547–53.CrossRefGoogle ScholarPubMed
27.Brown, GL. Clinical aspects of Q fever. Postgrad Med J 1973; 49: 539–41.Google Scholar
28.Marrie, TJ, Haldane, EV, Noble, MA et al. , Q fever in Maritime Canada. Can Med Assoc J 1982; 126: 1295–1300.Google ScholarPubMed
29.Millar, JK. The chest film findings in Q fever-a series of 35 cases. Clin Radiol 1978; 29: 371–5.CrossRefGoogle ScholarPubMed
30.Masbernard, A. Les localisations neurologiques des rickettsioses. Bull Soc Pathol Exot Filiales 1963; 56: 714–51.Google ScholarPubMed
31.Schwartz, RB. Manic psychosis in connection with Q fever. Br J Psychiatry 1974; 124: 140–3.Google Scholar
32.Ladurner, G, Stunzner, D, Lechner, H, Sixl, W. Q Fieber Meningoencephalitis—ein Fallbericht. Nervenarzt 1975; 46: 274–5.Google Scholar
33.Marrie, TJ. Pneumonia and meningoencephalitis due to Coxiella burnetii. J Infect 1985; 11: 59–61.Google Scholar
34.Schuil, J, Richardus, JH, Baarsma, GS, Schaap, GJP. Q fever as a possible cause of bilateral optic neuritis. Br J Ophthalmol 1985; 69: 580–3.CrossRefGoogle ScholarPubMed
35.Brooks, RG, Licitra, CM, Peacock, MG. Encephalitis caused by Coxiella burnetii. Ann Neurol 1986; 20: 91–3.CrossRefGoogle ScholarPubMed
36.Shaked, Y, Samra, Y. Q fever meningoencephalitis associated with bilateral abducens nerve paralysis, bilateral optic neuritis and abnormal cerebrospinal fluid findings. Infection 1989; 17: 394–5.CrossRefGoogle ScholarPubMed
37.Carausu, S. Aspecte electroencefalografice in febra Q. Rev Med Chir Soc Med Nat Iasi 1977; 81: 37–8.Google Scholar
38.Palmer, SR, Young, SEJ. Q fever endocarditis in England and Wales, 1975–81. Lancet 1982; ii: 1448–9.CrossRefGoogle Scholar
39.Ellis, ME, Smith, CC, Moffat, MAJ. Chronic or fatal Q fever infection: a review of 16 patients seen in North-East Scotland (1967–80). Q J Med 1983; L11 (205): 54–66.Google Scholar
40.Worswick, D, Marmion, BP. Antibody responses in acute and chronic Q fever and in subjects vaccinated against Q fever. J Med Microbiol 1985; 19: 281–96.CrossRefGoogle ScholarPubMed
41.Williams, JC, Thomas, LA, Peacock, MG. Identification of phase-specific antigenic fractions of Coxiella burnetii by enzyme-linked immunosorbent assay. J Clin Microbiol 1986; 24: 929–34.Google Scholar
42.Williams, JC, Thomas, LA, Peacock, MG. Humoral immune response to Q fever: enzyme-linked immunosorbent assay antibody response to Coxiella burnetii in experimentally infected guinea pigs. J Clin Microbiol 1986; 24: 935–9.CrossRefGoogle Scholar
43.Schmeer, N, Krauss, H, Werth, D, Schiefer, HG. Serodiagnosis of Q fever by enzyme-linked immunosorbent assay (ELISA). Zentralbl Bakteriol Mikrobiol Hyg [A] 1987; 267: 57–63.Google Scholar
44.Powell, OW, Stallman, ND. The incidence and significance of phase I complement fixing antibody in Q fever. J Hyg 1962; 60: 359–64.CrossRefGoogle ScholarPubMed
45.Winner, SJ, Eglin, RP, Moore, VIM, Mayon-White, RT. An outbreak of Q fever affecting postal workers in Oxfordshire. J Infect 1987; 14: 255–61.CrossRefGoogle ScholarPubMed
46.Turck, WPG, Howitt, G, Turnberg, LA et al. , Chronic Q fever. Q J Med 1976; XLV (178): 193–217.Google Scholar
47.World Health Organization. Meeting of the scientific group on rickettsial diseases in man. In: Report to the Director General. Geneva, 1963: 21.Google Scholar
48.Peacock, MG, Philip, RN, Williams, JC, Faulkner, RS. Serological evaluation of Q fever in humans: enhanced phase I titres of immunoglobulins G and A are diagnostic for Q fever endocarditis. Infect Immun 1983; 41: 1089–98.CrossRefGoogle Scholar
49.Edlinger, EA. Chronic Q fever. Zentralbl Bakteriol Mikrobiol Hyg [A] 1987; 267: 51–6.Google ScholarPubMed
50.Raoult, D, Urvolgyi, J, Etienne, J, Roturier, M, Puel, J, Chaudet, H. Diagnosis of endocarditis in acute Q fever by immunofluorescence serology. Acta Virol 1988; 32: 70–74.Google ScholarPubMed
51.Koster, FT, Williams, JC, Goodwin, JS. Cellular immunity in Q fever: specific lymphocyte unresponsiveness in Q fever endocarditis. J Infect Dis 1985; 152: 1283–9.CrossRefGoogle ScholarPubMed
52.Powell, OW, Kennedy, KP, McIver, M, Silverstone, H. Tetracycline in the treatment of Q fever. Aust Ann Med 1962; 11: 184–8.Google Scholar
53.Marmion, BP. Q fever. In: Smith, GR, ed. Topley and Wilson's principles of bacteriology, virology and immunity, 7th ed.London: Edward Arnold, 1984; 3: 583–7.Google Scholar
54.Ellis, ME, Dunbar, EM. In vivo response of acute Q fever to erythromycin. Thorax 1982; 37: 867–8.Google Scholar
55.Freeman, R, Hodson, ME. Q fever endocarditis treated with trimethoprim and sulpha-methoxazole. Br Med J 1972; 1: 419–20.Google Scholar
56.Yeaman, MR, Mitscher, LA, Baca, OG. In vitro susceptibility of Coxiella burnetii to antibiotics, including several quinolones. Antimicrob Agents Chemother 1987; 31: 1079–84.Google Scholar
57.Salmon, MM, Howells, B, Glencross, EJG, Evans, AD, Palmer, SR. Q fever in an urban area. Lancet 1982; i: 1002–4.Google Scholar
58.Smith, G. Q fever outbreak in Birmingham, U.K. Lancet 1989; ii: 557.Google Scholar