Open AccessClinical Characteristics of Q Fever and Etiology of Community-Acquired Pneumonia in a Tropical Region of Southern Taiwan: A Prospective Observational Study
Author(s) -
Chung-Hsu Lai,
LinLi Chang,
Jiun-g Lin,
Weifang Chen,
Yufeng Wei,
Chih-Yi Chiu,
Jiunn Yih Wu,
ChiKuei Hsu,
Jung-Yueh Chen,
Ho-Sheng Lee,
Hans Hsienhong Lin,
Yen-Hsu Chen
Publication year - 2014
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0102808
Subject(s) - q fever , coxiella burnetii , mycoplasma pneumoniae , streptococcus pneumoniae , community acquired pneumonia , pneumonia , chlamydophila pneumoniae , serology , klebsiella pneumonia , medicine , immunology , biology , virology , chlamydia , microbiology and biotechnology , antibiotics , antibody , staphylococcus aureus , genetics , chlamydiaceae , bacteria
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.