ACUTE Q-FEVER PNEUMONIA - A REVIEW OF 80 HOSPITALIZED-PATIENTS

Study objectives: To emphasize epidemiologic, clinical, or radiologic characteristics whose detection could lead to an early diagnosis and t o enhance therapeutic efficacy. Patients: Eighty hospitalized patients from 1982 to 1996. Design: The diagnosis of Q fever infection was ser ologically confirmed in all the patients (phase II Coxiella burnetii a ntibody) using the complement fixation test and/or the indirect immuno fluorescence antibody test. Results: Patients from rural and urban are as were noted in the same proportion; however, the usual epidemiologic factors such as contact with cats or farm animals were found in 40% o f the patients. Mean age +/- SD was 49 +/- 20 years, and there was a h igher sex ratio of male to female patients (1:3.44). We found a specif ic seasonal distribution since 80% of the cases occurred between Febru ary and May. Delay before referring to hospital was 8.2 +/- 7.8 days, while 69.3% of the patients received an antibiotic treatment that was mainly penicillin or cephalosporin. The dominant clinical features wer e dry cough and high fever, as the maximal temperature reached more th en 40 degrees C in 58% of the patients. Digestive symptoms were rare. WBC count remained within normal range in 80% of the cases with a low proportion of lymphocytes in half of the patients, and the sedimentati on rate was usually elevated (55 +/- 34 mm), Altered liver function co nsisted more frequently in an elevated level of alkaline phosphatase ( 70% of the cases) than transaminases, while hyponatremia was frequentl y mentioned (28.2% of the patients). We found radiologic evidence of u nique lobar or segmental alveolar opacity involving more likely the lo wer lobes in 55 patients, and multiple or interstitial opacities in th e others, Chest radiographs were considered normal in eight patients. The clinical response was favorable in all the patients with a reducti on in fever 4.8 +/- 3.9 days after the start of treatment with the sec ond antibiotic that included mainly erythromycin or quinolones, and ch est radiographs returned to normal in 81% of the patients within the f irst month.