305. Acute Q Fever in Israel: Clinical and Demographic Data 2006-2016
Session: Poster Abstract Session: Global Infections
Thursday, October 5, 2017
Room: Poster Hall CD
Posters
  • IDWeek 2017 305 Q fever.pdf (161.3 kB)
  • Background:

    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.

    Methods:

    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.

    Results:

    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.

    Conclusion:

    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.

    Sharon Reisfeld, MD1,2, Shayma Hasadia Mhamed, MD3, Michal Stein, MD1,2 and Michal Chowers, md4,5, (1)Ruth & Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel, (2)Infectious Diseases Unit, Hillel Yaffe Medical Center, Hadera, Israel, (3)Internal Medicine B, Hillel Yaffe Medical Center, Hadera, Israel, (4)Infectious Disease, Meir Medical Center, Kfar Saba, Israel, (5)Sackler Faculty of Medicine, Tel Aviv university, Tel Aviv, Israel

    Disclosures:

    S. Reisfeld, None

    S. Hasadia Mhamed, None

    M. Stein, None

    M. Chowers, None

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