Q-FEVER IN CHILDREN WITH ACUTE-LEUKEMIA

Purpose: Q fever is an infectious disease caused by the organism Coxie lla burnetii, a strictly intracellular rickettsia. Clinical manifestat ions of Q fever may resemble malignant hematologic abnormalities, and the evidence of association between Q fever and cancer is increasing. Therefore, the authors investigated the interaction of acute leukemia and Q fever in children. Methods: The study group consisted of 16 pati ents who were admitted for different time periods to Yonsei Medical Ce nter from August 1991 to September 1993. Clinical findings were evalua ted retrospectively. C. burnetii was identified in lymphocytes or bone marrow cells by transmission electron microscopy and immunofluorescen ce staining. Results: There was no statistically significant differenc e of incidence in boys and girls. The median age of onset was 4 4/12 y ears. Patients having C. burnetii were more frequently encountered in acute myeloid leukemia (AML) group than in the acute lymphoid leukemia (ALL) group. There were two 3-month-old infants with ALL, and one of them showed a high leukocyte count (629 x 10(9)/l). The most frequent type of AML was M5 (acute monocytic leukemia). The serious clinical ma nifestations observed in AML patients having Q fever were pulmonary ed ema, respiratory failure, and disseminated intravascular coagulation. In the AML group, three patients died 5 days after admission and two p atients died during remission induction. Extensive expansion of monobl astic clones in bone marrow was observed in three patients. Conclusion s: These observations emphasize that C. burnetii can induce serious in fection in patients with acute leukemia, and acute leukemia can change the clinical features of Q fever.