[Outbreak of Coxiella burnetii pneumonia]. / Brote epidémico de neumonía por Coxiella burnetii.

OBJECTIVE: The aim of this study was to describe an outbreak of Q fever pneumonia in the North of Spain. MATERIAL AND METHODS: We report 60 cases of Coxiella burnetii pneumonia in a rural area with 16,000 inhabitants during January and February 2003. The diagnosis was serologically confirmed by indirect immunofluorescence. RESULTS: Mean age of the patients was 46 years and the male/female ratio was 2.5. Overall, 52% of the patients lived in urbanized areas and contact with animals was declared in only 7% of patients. Sixty percent of patients were hospitalized. The most frequent clinical presentation was an acute febrile process (100%) and headache (80%); respiratory symptoms were infrequent. The most common liver function alteration was elevated transaminase levels (35%). Radiologic evidence of a single lobar or segmental alveolar opacity was found in 87% of patients, and most commonly affected the lower lobes. Chest radiographs returned to normal in 70% of patients within the two first months. Empirical treatment consisted of beta-lactams and macrolides in 38%, macrolides alone in 8%, and quinolones in 23%; 27% were treated with beta-lactams alone. No deaths occurred. CONCLUSIONS: Coxiella burnetii infection is very prevalent in the north of Spain and should be suspected and investigated when outbreaks of a pneumonic illness occur.

Brote epidémico de neumonía por Coxiella burnetii / Outbreak of Coxiella burnetii pneumonia

Objetivo. El propósito del estudio es describir un brote epidémico de neumonía por Coxiella burnetii que ocurrió en un área rural del norte de España. Material y métodos. Se describen 60 casos de neumonía por C. burnetii en un área rural de 16.000 habitantes del norte de España durante enero y febrero de 2003. El diagnóstico fue confirmado serológicamente por inmunofluorescencia indirecta. Resultados. La edad media fue de 46 años siendo la relación varón/mujer de 2,5. El 52% de los pacientes vivían en un área urbana y solamente el 7% referían contacto con animales. Fueron hospitalizados el 60% de los pacientes. La clínica más frecuente fue un proceso febril agudo (100%) y cefalea (80%) con escasos síntomas respiratorios. La alteración hepática más frecuente fue la elevación de las transaminasas (35%). Las alteraciones radiológicas consistieron en una condensación alveolar lobular o segmentaria en el 87% de los pacientes siendo los lóbulos inferiores los más frecuentemente afectados. La radiografía de tórax se normalizó en el 70% de los pacientes en los primeros 2 meses. El tratamiento empírico utilizado con mayor frecuencia fueron los betalactámicos asociados a macrólidos en el 38%, solamente macrólidos en el 8% y quinolonas en el 23% de los casos. El 27% de los pacientes fueron tratados únicamente con betalactámicos. Ningún paciente falleció. Conclusiones. La infección por C. burnetii es muy prevalente en el norte de España y debe de ser sospechada e investigada en aquellos casos de brote epidémico neumónico (AU)

Objective. The aim of this study was to describe an outbreak of Q fever pneumonia in the North of Spain. Material and methods. We report 60 cases of Coxiella burnetii pneumonia in a rural area with 16,000 inhabitants during January and February 2003. The diagnosis was serologically confirmed by indirect immunofluorescence. Results. Mean age of the patients was 46 years and the male/female ratio was 2.5. Overall, 52% of the patients lived in urbanized areas and contact with animals was declared in only 7% of patients. Sixty percent of patients were hospitalized. The most frequent clinical presentation was an acute febrile process (100%) and headache (80%); respiratory symptoms were infrequent. The most common liver function alteration was elevated transaminase levels (35%). Radiologic evidence of a single lobar or segmental alveolar opacity was found in 87% of patients, and most commonly affected the lower lobes. Chest radiographs returned to normal in 70% of patients within the two first months. Empirical treatment consisted of beta-lactams and macrolides in 38%, macrolides alone in 8%, and quinolones in 23%; 27% were treated with beta-lactams alone. No deaths occurred. Conclusions. Coxiella burnetii infection is very prevalent in the north of Spain and should be suspected and investigated when outbreaks of a pneumonic illness occur (AU)