Background

Forms of presentation of Q fever vary widely across Spain, with differences between the north and south. In the absence of reported case series from Galicia (north-west Spain), this study sought to describe a Q-fever case series in this region for the first time, and conduct a systematic review to analyse all available data on the disease in Spain.

Methods

Patients with positive serum antibodies to Coxiella burnetii from a single institution over a 5-year period (January 2011-December 2015) were included. Patients with phase II titres above 1/128 (or documented seroconversion) and compatible clinical criterial were considered as having Q fever. Patients with clinical suspicion of chronic Q-fever and IgG antibodies to phase I-antigen of over 1/1024, or persistently high levels six months after treatment were considered to be cases of probable chronic Q-fever. Systematic review: We conducted a search of the Pubmed/Medline database using the terms: Q Fever OR Coxiella burnetii AND Spain. Our search yielded a total of 318 studies: 244 were excluded because they failed to match the main criteria, and 41 were discarded due to methodological problems, incomplete information or duplication. Finally, 33 studies were included.

Results

A total of 155 patients, all of them from Galicia, with positive serological determination were located during the study period; 116 (75%) were deemed to be serologically positive patients without Q fever and the remaining 39 (25%) were diagnosed with Q fever. A potential exposure risk was found in 2 patients (5%). The most frequent form of presentation was pneumonia (87%), followed by isolated fever (5%), diarrhoea (5%) and endocarditis (3%). The main symptoms were headache (100%), cough (77%) and fever (69%). A trend to a paucisymptomatic illness was observed in women. Hospital admission was required in 37 cases, and 6 patients died while in hospital. Only 2 patients developed chronic Q-fever. Systematic review: Most cases were sporadic, mainly presented during the winter and spring, as pneumonia in 37%, hepatitis in 31% and isolated fever in 29.6% of patients. In the north of Spain, 71% of patients had pneumonia, 13.2% isolated fever and 13% hepatitis. In the central and southern areas, isolated fever was the most frequent form of presentation (40%), followed by hepatitis (38.4%) and pneumonia (17.6%). Only 31.7% of patients reported risk factors, and an urban-environment was the most frequent place of origin. Overall mortality was 0.9%, and the percentage of patients with chronic forms of Q-fever was 2%.

Conclusions

This is the first study to report on a Q-fever case series in Galicia. It shows that in this region, the disease affects the elderly population -even in the absence of risk factors- and is linked to a higher mortality than reported by previous studies. While pneumonia is the most frequent form of presentation in the north of the country, isolated fever and hepatitis tend to be more frequent in the central and southern areas. In Spain, 32% of Q-fever cases do not report contact with traditional risk factors, and around 58% live in urban areas.

中文翻译：

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西班牙的Q发烧：新系列的描述和系统评价

背景

在西班牙，Q热的表现形式差异很大，南北之间也有所不同。在没有加利西亚（西班牙西北部）报道的病例系列的情况下，本研究试图首次描述该地区的Q型热病病例系列，并进行系统的综述以分析西班牙有关该疾病的所有可用数据。

方法

纳入了在5年期间（2011年1月至2015年12月）来自单一机构的针对伯氏柯氏杆菌的血清抗体呈阳性的患者。II期滴度高于1/128（或记录的血清转化）且临床标准相符的患者被视为Q发热。临床怀疑慢性Q发热和I期抗原IgG抗体超过1/1024或在治疗后六个月持续高水平的患者被认为是可能的慢性Q发热病例。系统评价：我们使用以下术语搜索Pubmed / Medline数据库：Q Fever或Coxiella burnetii AND西班牙。我们的搜索总共进行了318项研究：244项因为不符合主要标准而被排除在外； 41项由于方法学问题，信息不完整或重复而被丢弃。最后，纳入了33项研究。

结果

在研究期间，共有155名患者（均来自加利西亚，血清学检查呈阳性）；116例（75％）被认为是没有Q发热的血清学阳性患者，其余39例（25％）被诊断为Q发热。发现有2位患者（5％）的潜在暴露风险。最常见的表现形式是肺炎（87％），其次是单纯发烧（5％），腹泻（5％）和心内膜炎（3％）。主要症状是头痛（100％），咳嗽（77％）和发烧（69％）。在妇女中观察到有小症状的趋势。37例需要住院治疗，其中6例在住院期间死亡。仅2例患者出现了慢性Q热。系统评价：大多数病例是散发性的，主要在冬季和春季出现，肺炎占37％，肝炎占31％，单纯发烧占29.6％。在西班牙北部，71％的患者患有肺炎，13.2％的单纯发烧和13％的肝炎。在中部和南部地区，单纯发烧是最常见的表现形式（40％），其次是肝炎（38.4％）和肺炎（17.6％）。只有31.7％的患者报告了危险因素，并且城市环境是最常见的出身地。总体死亡率为0.9％，患有慢性Q型热的患者的比例为2％。

结论

这是加利西亚首次报告Q发热病例系列的研究。它表明，在该地区，即使没有危险因素，该病也影响老年人口，并且与以前的研究报道的死亡率较高有关。肺炎是该国北部最常见的表现形式，而中部和南部地区孤立发烧和肝炎的发病率则更常见。在西班牙，有32％的Q发热病例没有报告与传统危险因素的接触，大约58％的人生活在城市地区。