RESUMO
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.
Assuntos
Coxiella burnetii/isolamento & purificação , Surtos de Doenças , Pneumonia Bacteriana/epidemiologia , Febre Q/epidemiologia , Adulto , Animais , Animais Domésticos/microbiologia , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/transmissão , Serviço Hospitalar de Emergência/estatística & dados numéricos , Doenças Endêmicas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/epidemiologia , Pneumonia Bacteriana/diagnóstico , Pneumonia Bacteriana/microbiologia , Febre Q/diagnóstico , Febre Q/transmissão , Estudos Retrospectivos , População Rural , Espanha/epidemiologia , ZoonosesRESUMO
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)
