Analysis on the clinical characteristics of acute Q fever in 6 cases
Objective To analyze the epidemiology,clinical pictures,diagnosis and treatment of acute Q fever in order to provide reference for the diagnosis and treatment of this entity.Methods Retrospective study was conducted on the 6 cases of acute Q fever diagnosed by metagenomics next-generation sequencing(mNGS)in Nantong Third People's Hospital between May 2022 and August 2023.The data were collected and analyzed including the epidemiological histo-ry,past medical history,clinical manifestations,findings of laboratory tests,mNGS and imaging,diagnosis and treat-ment process and treatment outcome.Results All the 6 patients were males,aged 45-59 years.Four patients had a his-tory of wild-fishing by the river many times,one had a history of fishing out the bird's nests,and another one was liv-ing with sheep around his settlement before the disease onset.The onset occurred at any time throughout the year.The clinical manifestations were high fever in all patients(6/6),with remittent-fever being dominant(5/6).Other clinical pic-tures included weakness(6/6),chills(5/6),muscle pain(5/6),and poor appetite(4/6).Laboratory studies indicated de-creased white blood cell(WBC)count in peripheral blood in 2 and decreased platelet count in 3 patients.Elevated lev-els of alanine aminotransferase,aspartate aminotransferase and lactate dehydrogenase were seen in all the 6 patients,and increased creatine kinase was observed in 4.All patients had notably increased levels of C-reactive protein,procalci-tonin,ferritin and D-dimer,and three had mildly escalated erythrocyte sedimentation rate.Pneumonia was free in the 6 patients by chest CT detection,and no endocarditis was seen in the 5 patients undergone echocardiography.Coxiella bur-netii(Cb)was detected by mNGS in the 6 patients,who were confirmed as acute Q fever.All patients were recovered and discharged after medication with doxycycline(2 cases)or doxycycline combined with moxifloxacin(4 cases).Con-clusion The clinical manifestations,imaging and laboratory test results of acute Q fever are unspecific,and the epide-miological history appears inconclusive in some patients.mNGS can contribute to quick and definitive diagnosis in the suspected patients,and doxycycline and moxifloxacin are effective in treatment of this infection.
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