The clinical spectrum of the acute disease varies in different locations around the world. Israel is endemic for Q fever, and our hospital is located in a hyper-endemic area. The aim of our study was to describe the clinical characteristic of acute Q fever in our area.
A historical cohort, including adult patients with a serologic diagnosis of Q fever. Demographic, clinical, laboratory and imaging data were collected and analyzed. Serologic definitions for an acute disease were IgM phase 2 ≥50 and / or IgG phase 2 ≥100, and chronic disease was defined as IgG phase 1≥800.
During 2006-2016, 3352 blood samples were sent for serology to the reference laboratory, 205 (6.1%) were positive for Q fever. We observed an increase in positive results from 1.3%-3.7% in 2007-2011 to 3.9%-7.3% during 2012-2015, and up to 41% in 2016. Full data was available for 153 patients.
Ninety nine patients (65%) were male, median age was 50 years, and half of the patients had no comorbidities. The patients presented with fever in 85% of the cases, a respiratory symptom in 58%, rash was present in 7%.
Anemia was present in 46 patients (30%), but leukopenia and thrombocytopenia were less common (6% and 16% respectively). Liver enzymes were elevated in 29 patients (19%), and 49 patients (32%) had pneumonia according to chest x-ray.
Seventeen patients had risk factors for a chronic disease: 3 of those had chronic infection at presentation, 4 patients had an appropriate follow up; one patient developed a chronic disease shortly after the acute infection. Three patients died from other severe medical conditions and 7 patients were not followed up.
Although only 46 patients (30%) were discharged with a diagnosis of either Q fever or unspecified rickettsial disease, 74 (48%) were treated with doxycycline.
Most of our patients had an unspecified febrile illness, 81% of them had normal liver tests, as oppose to published data from Israel and Europe, where elevated liver enzymes were reported in the vast majority of patients. Although there is a high index of suspicion and the acute disease is diagnosed frequently, only 4 out of 11 high risk patients had an appropriate follow up. Education about the management of high risk patients is warranted.
M. Stein, None
M. Chowers, None