Molecular detection of Coxiella burnetii from the formalin-fixed tissues of Q fever patients with acute hepatitis

• Published in: PloS one 2017-07, Vol.12 (7), p.e0180237-e0180237
• Main Authors: Jang, Young-Rock, Shin, Yong, Jin, Choong Eun, Koo, Bonhan, Park, Se Yoon, Kim, Min-Chul, Kim, Taeeun, Chong, Yong Pil, Lee, Sang-Oh, Choi, Sang-Ho, Kim, Yang Soo, Woo, Jun Hee, Kim, Sung-Han, Yu, Eunsil
• Format: Article
• Language: English
• Subjects: Acute Disease; Adult; Aged; Antibodies; Antibody response; Biology and Life Sciences; Biopsy; Bone marrow; Causes of; Circumferences; Coxiella burnetii - genetics; Coxiella burnetii - isolation & purification; Criteria; Deoxyribonucleic acid; Departments; Deposition; Diagnosis; Diagnostic systems; DNA; Dosage and administration; Endocarditis; Fever; Fibrin; Formaldehyde; Granuloma; Granulomas; Health risk assessment; Hepatitis; Hepatitis - complications; Humans; Immunoglobulin G; Infections; Infectious diseases; Influence; Internal medicine; Laboratories; Liver; Male; Medicine; Medicine and Health Sciences; Middle Aged; Pathology; Patients; Polymerase chain reaction; Q fever; Q Fever - complications; Q Fever - pathology; Research and Analysis Methods; Retrospective Studies; Rickettsiae; Risk analysis; Risk factors; Tissue Fixation; Tissues; Transaminase
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0180237

Serologic diagnosis is one of the most widely used diagnostic methods for Q fever, but the window period in antibody response of 2 to 3 weeks after symptom onset results in significant diagnostic delay. We investigated the diagnostic utility of Q fever PCR from formalin-fixed liver tissues in Q fever patients with acute hepatitis. We reviewed the clinical and laboratory data in patients with Q fever hepatitis who underwent liver biopsy during a 17-year period, and whose biopsied tissues were available. We also selected patients who revealed granuloma in liver biopsy and with no Q fever diagnosis within the last 3 years as control. Acute Q fever hepatitis was diagnosed if two or more of the following clinical, serologic, or histopathologic criteria were met: (1) an infectious hepatitis-like clinical feature such as fever (≥ 38°C) with elevated hepatic transaminase levels; (2) exhibition of a phase II immunoglobulin G (IgG) antibodies titer by IFA of ≥ 1:128 in single determination, or a four-fold or greater rise between two separate samples obtained two or more weeks apart; (3) histologic finding of biopsy tissue showing characteristic fibrin ring granuloma. A total of 11 patients with acute Q fever hepatitis were selected and analyzed. Of the 11 patients, 3 (27%) had exposure to zoonotic risk factors and 7 (63%) met the serologic criteria. Granulomas with either circumferential or radiating fibrin deposition were observed in 10 cases on liver biopsy and in 1 case on bone marrow biopsy. 8 (73%) revealed positive Coxiella burnetii PCR from their formalin-fixed liver tissues. In contrast, none of 10 patients with alternative diagnosis who had hepatic granuloma revealed positive C. burnetii PCR from their formalin-fixed liver tissues. Q fever PCR from formalin-fixed liver tissues appears to be a useful adjunct for diagnosing Q fever hepatitis.