Volume 14, Issue 3 (11-2024)
Clin Exc 2024, 14(3): 53-67 |
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Baseri N, Mostafavi E. A Review of Infectious Q Fever Hepatitis. Clin Exc 2024; 14 (3) :53-67
URL: http://ce.mazums.ac.ir/article-1-873-en.html
URL: http://ce.mazums.ac.ir/article-1-873-en.html
Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
Abstract: (368 Views)
Hepatitis or liver parenchymal inflammation is a major medical concern worldwide that can lead to inevitable death if left untreated and becomes chronic. Hepatitis can occur due to various reasons, including infectious (e.g., hepatitis A, B, and C viruses) and non-infectious (e.g., alcohol use, side effects of medications, some toxins, and autoimmune disease) factors. Coxiella burnetii, an obligate intracellular bacterium and the causative agent of Q fever, is recognized as one of the known causes of granulomatous hepatitis worldwide, especially in endemic areas of Q fever. Q fever presents with variable clinical manifestations; however, most infected patients are asymptomatic and undiagnosed.
Acute and chronic symptomatic infections manifest in two forms. Acute hepatitis often occurs in patients infected with Q fever. Acute Q fever hepatitis seldom develops into a chronic, widely distributed variant. The liver may sometimes be affected by Q fever-related disseminated endocarditis.
From clinical, laboratory, and pathological manifestations, predominant acute hepatitis due to Q fever can be identified by symptoms, such as fever, headache, elevated transaminase enzymes, presence of granulomas, inflammatory cells, as well as fibrin rings in liver and bone marrow biopsy. The diagnosis of hepatitis caused by C. burnetii is made through clinical symptoms along with increased IgG phase II antibody levels or molecular evidence of C. burnetii presence in liver biopsy.
In Iran, investigations into infectious hepatitis cases typically involve testing for viral infections, such as hepatitis A, B, and C. However, no comprehensive analysis has been conducted to date to determine if suspicious samples include C. burnetii. Since hepatitis is one of the most common diseases in Iran and C. burnetii is an endemic infection in Iran, the present review aimed to alert Iranian physicians to the possibility that some cases of infectious hepatitis in Iran may be caused by C. burnetii infection. Therefore, it is suggested that patients with non-viral hepatitis (especially granulomatous hepatitis) with clinical symptoms, such as acute fever of unknown origin or prolonged fever, especially in high-risk individuals for Q fever infection (e.g., farmers and livestock handlers), should undergo serological indirect immunofluorescence (in acute or chronic phase) and molecular testing (in acute phase) for Q fever. In addition, acute Q fever hepatitis should be added to the differential diagnoses of this group of patients to assist healthcare professionals in controlling and treating this disease in Iran.
Acute and chronic symptomatic infections manifest in two forms. Acute hepatitis often occurs in patients infected with Q fever. Acute Q fever hepatitis seldom develops into a chronic, widely distributed variant. The liver may sometimes be affected by Q fever-related disseminated endocarditis.
From clinical, laboratory, and pathological manifestations, predominant acute hepatitis due to Q fever can be identified by symptoms, such as fever, headache, elevated transaminase enzymes, presence of granulomas, inflammatory cells, as well as fibrin rings in liver and bone marrow biopsy. The diagnosis of hepatitis caused by C. burnetii is made through clinical symptoms along with increased IgG phase II antibody levels or molecular evidence of C. burnetii presence in liver biopsy.
In Iran, investigations into infectious hepatitis cases typically involve testing for viral infections, such as hepatitis A, B, and C. However, no comprehensive analysis has been conducted to date to determine if suspicious samples include C. burnetii. Since hepatitis is one of the most common diseases in Iran and C. burnetii is an endemic infection in Iran, the present review aimed to alert Iranian physicians to the possibility that some cases of infectious hepatitis in Iran may be caused by C. burnetii infection. Therefore, it is suggested that patients with non-viral hepatitis (especially granulomatous hepatitis) with clinical symptoms, such as acute fever of unknown origin or prolonged fever, especially in high-risk individuals for Q fever infection (e.g., farmers and livestock handlers), should undergo serological indirect immunofluorescence (in acute or chronic phase) and molecular testing (in acute phase) for Q fever. In addition, acute Q fever hepatitis should be added to the differential diagnoses of this group of patients to assist healthcare professionals in controlling and treating this disease in Iran.
Type of Study: Review |
Subject:
عفوني
Received: 2024/09/27 | Accepted: 2025/01/14 | Published: 2025/01/14
Received: 2024/09/27 | Accepted: 2025/01/14 | Published: 2025/01/14
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