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Coxiella Burnetii Infection In Patients With Various Diseases

Journal of the Korean Pediatric Society 1994;37(3):356-367.
Published online March 15, 1994.
Coxiella Burnetii Infection In Patients With Various Diseases
Kyo Sun Kim1, Won Young Lee2
1Department of Pediatrics, Konkuk University College of Medicine, Chungju, Korea
2Department of Microbiology,Yonsei University College of Medicine, Seoul, Korea
Coxiella burnetii 감염과 여러 질환과의 관련성에 관한 연구
김교순1, 이원영2
1건국대학교 의과대학 소아과학교실
2연세대학교 의과대학 미생물학교실
Coxiella burnetii(C. burneii) was first recognzed as the agent of Q fever in 1937. Q fever is an acute self-limited febrile illness. However, it manifests with several clinical symptoms depending upon the organs that are involved. The association of C. burnetii with human neoplasia has been rarely reported. We prospectively studied the 55 patients with fever of unknown origin, pneumonia, hepatos-plenomegaly, lymphadenopathy, leukemia, lymphoma, and immunodeficiency and 14 persons who contacted the Q fever patients. The patient's sera were tested for antibodies specific for C. burnetii, using indirct fluorescent antibody techniques(IFA). 1) We serologically confirmed 23 C. burnetii infection. The 23 children with Q fever ranged in age from 0 to 15 years, with mean age of 4 years 11 months. Seventeen were boys and 6 were girls. 2) Characteristic symptoms and signs were fever (9/12 cases), rash (8/12 cases), hepatos-plenomegaly (8/8 cases) and lymphadenopathy (14/27 cases). Five cases among 14 asymptomatic cases who contacted Q fever patients showed positive IFA test. One suffered from irregular uterine contraction, 4 weeks after contact with a Q fever patient. 3) There were no history of exposure to domestic animal carriers or contaminated dust, or drinking raw milk except one family. Three attending doctors and her father infected by a patient with Q fever. These suggested the person to person transmission of Q fever in a family and house staffs infected by a patient of Q fever. 4) Q fever (9 cases), acute lymphoblastic leukemia (2 cases), acute myelomonocytic leukemia (1 case), hairy cell leukemia (1 case), Kawasake disease (4 cases) and congenital dyserythropoietic anemia (1 case) showed positive IFA test. 5) Of 9 cases who suffered from only Q fever, 7 cases were confirmed hairy cell formation in their peripheral blood. One case was diagnosed as hairy cell leukemia after bone marrow study. Of 7 cases who showed hairy cells, all had hepatomegaly, 6 cases had lymphadenopathy and 5 cases showed splenomegaly. All except 1 case who was not followed cured after treatment. 6) We treated Q fever patients with rifampin and/or ciprofloxacin, and/or tetracyclin (over 8 year-old of age) for 2-4weeks. One 25 month-old patient with hairy cell leukemia was treated with rifampin, ciprofloxacin and tetracyclin for 4 weeks, and rifampin for 8 months. A pregnant patient was administered with rifampin, and treated with rifampin and ciprofloxacin after delivery. We gave rifampin in one newborb baby. In conclusion, we suggest that Q fever should be considered in the differential diagnosis of patients with FUO, hepatosplenomegaly and/or immunodeficiency.
Key Words: C. burnetii infection, children, leukemia, hairy cell formation

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