背景:Q发烧,由人畜共患病原体伯氏杆菌引起,表现出世界性流行。在中国,Q发烧不被认为是应报告的疾病,这种疾病在临床实践中被忽视和低估,导致诊断挑战。
方法:我们介绍了在2022年至2023年之间诊断为持续Q热的3例患者的病例系列。我们三例病例的平均年龄为63.33岁,由两名男性和一名女性组成。这些人的病史包括以前的瓣膜置换,动脉瘤,然后进行主动脉支架植入术和人工髋关节置换。在疾病发作时,只有一例出现急性发热,其余两例无任何急性症状。病因最初被忽略,直到宏基因组下一代测序测试从血液或活检样本中鉴定出伯氏柯西氏菌。发现诊断延迟,从疾病发作到确认之间的持续时间从三个月到一年不等。流行病学史发现,这三例病例均未直接接触家畜或食用未经巴氏消毒的乳制品。案例1和2居住在城市地区,而案例3是一名从事农业的农村居民。所有患者均接受多西环素和羟氯喹联合治疗,并且在随访期间没有观察到该疾病的复发。
结论:Q发热在我国临床实践中很少被诊断和报道。我们应该意识到高危人群中持续的Q热,即使有平淡无奇的曝光历史。宏基因组下一代测序作为一种诊断工具,具有巨大的潜力,可用于识别稀有和挑剔的病原体,例如柯西氏菌。
BACKGROUND: Q fever, caused by the zoonotic pathogen Coxiella burnetii, exhibits a worldwide prevalence. In China, Q fever is not recognized as a notifiable disease, and the disease is overlooked and underestimated in clinical practice, leading to diagnostic challenges.
METHODS: We present a
case series of three patients diagnosed with persistent Q fever between 2022 and 2023. The average age of our three cases was 63.33 years old, consisting of two males and one female. The medical history of the individuals included previous valve replacement, aneurysm followed by aortic stent-graft placement and prosthetic hip joint replacement. At the onset of the disease, only one
case exhibited acute fever, while the remaining two cases were devoid of any acute symptoms. The etiology was initially overlooked until metagenomic next-generation sequencing test identified Coxiella burnetii from the blood or biopsy samples. Delayed diagnosis was noted, with a duration ranging from three months to one year between the onset of the disease and its confirmation. The epidemiological history uncovered that none of the three cases had direct exposure to domestic animals or consumption of unpasteurized dairy products.
Case 1 and 2 resided in urban areas, while
Case 3 was a rural resident engaged in farming. All patients received combination therapy of doxycycline and hydroxychloroquine, and no recurrence of the disease was observed during the follow-up period.
CONCLUSIONS: Q fever is rarely diagnosed and reported in clinical practice in our country. We should be aware of persistent Q fever in high-risk population, even with unremarkable exposure history. Metagenomic next-generation sequencing holds great potential as a diagnostic tool for identifying rare and fastidious pathogens such as Coxiella burnetii.