急性Q热引起高热、肝损伤1例并文献复习

High fever and liver injury caused by acute Q fever: a case report and literature review

目的回顾1例发热伴肝损伤患者的诊治经过, 提高对Q热的认识, 为类似患者的诊治思路提供借鉴。方法报道1例经宏基因组二代测序诊断的急性Q热。以"Q热"为关键词检索中国知网数据库, 检索时间从1950年1月到2021年10月。结果共检索到133篇文献, 筛选其中具有比较完整的临床资料的国内个案22例, 加上本文报道1例, 共23例, 23例均为散发病例。男19例(82.6%)、女4例(17.4%), 男女比例约为4.8∶1, 年龄范围为12~73岁。临床表现无特异性, 可表现为发热、咳嗽、咳痰、头疼、肌肉酸痛、黄疸、乏力等。实验室检查及影像学检查无特异性, 漏诊率极高, 确诊需要依据血清学抗体, 目前宏基因组二代测序能提高确诊率。多西环素治疗有效。确诊后23例Q热患者经针对性治疗后均治愈。结论在我国, Q热仍是一类被忽视的烈性传染病, 临床中针对发热待查伴肝损伤患者, 需警惕Q热的可能, 减少因漏诊导致严重并发症及死亡的发生。

ObjectiveTo improve clinicians′ understanding of Q fever and provide reference for the diagnosis and treatment of patients with similar symptoms, and to review the diagnosis and treatment process of a patient with fever and liver function injury.MethodsOne case of acute Q fever diagnosed by metagenomic nest generation sequencing (mNGS) was reported." Q fever" was used as key words to search CNKI database, and the search time was set from January 1950 to October 2021.ResultsA total of 133 articles were retrieved and 22 domestic cases with relatively complete clinical data were selected.Including the case reported in this article, a total of 23 cases were reported in this paper.All were sporadic cases.There were 19 males (82.6%) and 4 females (17.4%), with the male to female ratio about 4.8∶1.The age range was 12 to 73 years old.Clinical manifestations were non-specific, including fever, cough, expectoration, headache, muscle soreness, jaundice, fatigue, etc.Laboratory and imaging examinations were non-specific, the missed diagnosis rate of initial diagnosis was very high, and confirmation can be made by serological antibodies.At present, metagenomic nest generation sequencing (mNGS) can improve the diagnostic rate.Doxycycline was proved effective in treatment.All 23 cases of patients with Q fever were cured after targeted treatment.ConclusionsIn China, Q fever is still a neglected but severe infectious disease.In clinical practice, if a patient has fever of unknown origin and liver function damage, we should be wary of the possibility of Q fever and try to reduce the occurrence of serious complications and deaths caused by missed diagnosis.