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Observational Study
. 2014 Jul 17;9(7):e102808.
doi: 10.1371/journal.pone.0102808. eCollection 2014.

Clinical characteristics of Q fever and etiology of community-acquired pneumonia in a tropical region of southern Taiwan: a prospective observational study

Chung-Hsu Lai  1 , Lin-Li Chang  2 , Jiun-Nong Lin  3 , Wei-Fang Chen  4 , Yu-Feng Wei  5 , Chien-Tung Chiu  5 , Jiun-Ting Wu  5 , Chi-Kuei Hsu  5 , Jung-Yueh Chen  5 , Ho-Sheng Lee  5 , Hsi-Hsun Lin  6 , Yen-Hsu Chen  7
Affiliations
Observational Study

Clinical characteristics of Q fever and etiology of community-acquired pneumonia in a tropical region of southern Taiwan: a prospective observational study

Chung-Hsu Lai et al. PLoS One. .

Abstract

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.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Flow chart of the recruitment of cases of community-acquired pneumonia (CAP) and Q fever.
Figure 2
Figure 2. The month and age distributions of study cases.
A: The month distributions of cases of community-acquired pneumonia (CAP) and Q fever. B: The age distributions of cases of CAP and Q fever.
Figure 3
Figure 3. The geographic location of Taiwan and distributions of study cases.
A: The geographic location of Taiwan. B: The cases’ geographic distributions for community-acquired pneumonia (CAP). C: The cases’ geographic distribution for Q fever.
Figure 4
Figure 4. The titers of antibodies in 12 cases of community-acquired pneumonia that were seropositive for anti-phase I and anti-phase II antibodies.
None had detectable IgM antibodies.
See this image and copyright information in PMC

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