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Neurological Involvement in Acute Q Fever
A Report of 29 Cases and Review of the Literature
Emmanuelle Bernit, MD;
Jean Pouget, MD;
François Janbon, MD;
Hervé Dutronc, MD;
Philippe Martinez, MD;
Philippe Brouqui, MD, PhD;
Didier Raoult, MD, PhD
Arch Intern Med. 2002;162:693-700.
Background Q fever is characterized by its clinical polymorphism; neurological
involvement has occasionally been described. In the course of acute Q fever,
neurological manifestations may include aseptic meningitis, encephalitis or
encephalomyelitis, and peripheral neuropathy.
Objective To review and evaluate cases of acute Q fever with neurological symptoms
diagnosed in our laboratory.
Methods A total of 1269 acute Q fever cases were recorded from January 1985
to January 2000 in our laboratory and were reviewed for neurological complications.
Patients were considered to have acute Q fever when serological procedures
showed Coxiella burnetii phase II titers of 1:200
or higher for IgG and 1:50 or higher for IgM. Those patients who underwent
a lumbar puncture for cerebrospinal fluid analysis or who had abnormal neurological
symptoms were selected for this study. We describe the clinical, epidemiological,
and biological features of these cases. We also review the literature and
compare our cases with those previously reported.
Results Among the 45 patients selected, 14 were excluded because they had normal
cerebrospinal fluid and no neurological symptoms. Two were excluded because
there were no clinical or epidemiological data. Three major clinical syndromes
were observed: meningoencephalitis or encephalitis in 17 cases; meningitis
in 8; and myelitis and peripheral neuropathy in 4. Encephalitic signs were
not specific, but behavior or psychiatric disturbances were common.
Conclusions Q fever should be included in the differential diagnosis of acute neurological
disease in a patient with a fever. Serological testing should be performed
in cases of meningoencephalitis, lymphocytic meningitis, and peripheral neuropathy,
including Guillain-Barré syndrome and myelitis.
From Unité des Rickettsies, Centre National de la Recherche
Scientifique (Drs Bernit, Brouqui, and Raoult) and Service de Neurologie,
Hôpital de La Timone (Dr Pouget), Marseille, France; Service de Maladies
Infectieuses, Hôpital Gui de Chauliac, Montpellier, France (Dr Janbon);
Service de Maladies Infectieuses, Hôpital Pellegrin-Tripode, Bordeaux,
France (Dr Dutronc); and Service de Neurologie, Hôpital de Rangueil,
Toulouse, France (Dr Martinez).
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