热带病与寄生虫学 ›› 2024, Vol. 22 ›› Issue (3): 188-192.doi: 10.3969/j.issn.1672-2302.2024.03.011

• 临床研究 • 上一篇    

6例急性Q热的临床特征分析

莫小英(), 王忠成, 姚超, 王芫梓, 汪美华()   

  1. 南通市第三人民医院,南通大学附属南通第三医院,江苏南通 226000
  • 收稿日期:2024-01-26 出版日期:2024-06-20 发布日期:2024-06-28
  • 通信作者: 汪美华,E-mail: wmh85834876@163.com
  • 作者简介:莫小英,女,硕士,主治医师,研究方向:感染病学。E-mail: 312550300@qq.com
  • 基金资助:
    江苏省中医药科技发展计划项目(MS2022093);南通市卫生健康委科研项目(MSZ2022044);南通市卫生健康委科研项目(QNZ2022038);南通市传染病防治联盟科技项目(20230800N04)

Analysis on the clinical characteristics of acute Q fever in 6 cases

MO Xiaoying(), WANG Zhongcheng, YAO Chao, WANG Yuanzi, WANG Meihua()   

  1. Nantong Third People’s Hospital, Nantong Third Hospital Affiliated to Nantong University, Nantong 226000, Jiangsu Province, China
  • Received:2024-01-26 Online:2024-06-20 Published:2024-06-28
  • Contact: WANG Meihua, E-mail: wmh85834876@163.com

摘要:

目的 分析急性Q热的流行病学、临床特征和诊治方法,以期为该病诊治提供参考。方法 收集2022年5月至2023年8月南通市第三人民医院确诊的6例急性Q热患者的流行病学史、既往病史、临床表现、实验室检查、宏基因组学二代测序(metagenomic next-generation sequencing, mNGS)结果、影像学表现及诊治过程等资料,对其进行回顾性分析。结果 6例急性Q热患者均为男性,年龄为45~59岁。4例患者发病前有多次野外钓鱼史,1例发病前有掏鸟窝史,1例居住地周围有羊群。发病时间呈全年散发。所有患者临床表现均有高热,热型以弛张热为主(5例),其他主要伴随症状有乏力(6例)、畏寒(5例)、肌肉酸痛(5例)、纳差(4例)。实验室检查中2例患者外周血白细胞计数减少,3例患者血小板计数减少;所有患者谷丙转氨酶、谷草转氨酶和乳酸脱氢酶均升高,4例患者肌酸激酶升高;所有患者C反应蛋白、降钙素原、铁蛋白、D-二聚体均明显升高;3例患者红细胞沉降率轻度升高。6例患者均行胸部CT检查,未见肺炎;5例患者行心脏超声检查,未见心内膜炎。6例患者的血液或骨髓标本均通过mNGS检出贝纳柯克斯体(Coxiella burnetii, Cb),确诊为急性Q热后,给予多西环素单药(2例)或多西环素联合莫西沙星(4例)治疗,所有患者好转出院。结论 急性Q热的临床表现、影像学及实验室检测缺乏特异性,部分患者缺乏明确的流行病学史,对可疑患者行mNGS可以快速明确诊断,多西环素、莫西沙星治疗效果明显。

关键词: Q热, 宏基因组学二代测序, 临床特征, 多西环素

Abstract:

Objective To analyze the epidemiology, clinical pictures, diagnosis and treatment of acute Q fever in order to provide reference for the diagnosis and treatment of this entity. Methods Retrospective study was conducted on the 6 cases of acute Q fever diagnosed by metagenomics next-generation sequencing (mNGS) in Nantong Third People’s Hospital between May 2022 and August 2023. The data were collected and analyzed including the epidemiological history, past medical history, clinical manifestations, findings of laboratory tests, mNGS and imaging, diagnosis and treatment process and treatment outcome. Results All the 6 patients were males, aged 45-59 years. Four patients had a history of wild-fishing by the river many times, one had a history of fishing out the bird’s nests, and another one was living with sheep around his settlement before the disease onset. The onset occurred at any time throughout the year. The clinical manifestations were high fever in all patients (6/6), with remittent-fever being dominant (5/6). Other clinical pictures included weakness (6/6), chills (5/6), muscle pain (5/6), and poor appetite (4/6). Laboratory studies indicated decreased white blood cell (WBC) count in peripheral blood in 2 and decreased platelet count in 3 patients. Elevated levels of alanine aminotransferase, aspartate aminotransferase and lactate dehydrogenase were seen in all the 6 patients, and increased creatine kinase was observed in 4. All patients had notably increased levels of C-reactive protein, procalcitonin, ferritin and D-dimer, and three had mildly escalated erythrocyte sedimentation rate. Pneumonia was free in the 6 patients by chest CT detection, and no endocarditis was seen in the 5 patients undergone echocardiography. Coxiella burnetii (Cb) was detected by mNGS in the 6 patients, who were confirmed as acute Q fever. All patients were recovered and discharged after medication with doxycycline (2 cases) or doxycycline combined with moxifloxacin (4 cases). Conclusion The clinical manifestations, imaging and laboratory test results of acute Q fever are unspecific, and the epidemiological history appears inconclusive in some patients. mNGS can contribute to quick and definitive diagnosis in the suspected patients, and doxycycline and moxifloxacin are effective in treatment of this infection.

Key words: Q fever, Metagenomics next-generation sequencing, Clinical features, Doxycycline

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