Q Fever as a Cause of Community-Acquired Pneumonia in French Guiana

• Published in: The American journal of tropical medicine and hygiene 2022-08, Vol.107 (2), p.407-415
• Main Authors: Epelboin, Loïc, Mahamat, Aba, Bonifay, Timothée, Demar, Magalie, Abboud, Philippe, Walter, Gaëlle, Drogoul, Anne-Sophie, Berlioz-Arthaud, Alain, Nacher, Mathieu, Raoult, Didier, Djossou, Félix, Eldin, Carole
• Format: Article
• Language: English
• Subjects: Effectiveness; Life Sciences; Pneumonia
• ISSN: 0002-9637; 1476-1645
• DOI: 10.4269/ajtmh.21-0711

In French Guiana, community-acquired pneumonia (CAP) represents over 90% of Coxiella burnetii acute infections. Between 2004 and 2007, we reported that C. burnetii was responsible for 24.4% of the 131 CAP hospitalized in Cayenne. The main objective of the present study was to determine whether the prevalence of Q fever pneumonia remained at such high levels. The secondary objectives were to identify new clinical characteristics and risk factors for C. burnetii pneumonia. A retrospective case-control study was conducted on patients admitted in Cayenne Hospital, between 2009 and 2012. All patients with CAP were included. The diagnosis of acute Q fever relied on titers of phase II IgG ≥ 200 and/or IgM ≥ 50 or seroconversion between two serum samples. Patients with Q fever were compared with patients with non- C. burnetii CAP in bivariate and multivariate analyses. During the 5-year study, 275 patients with CAP were included. The etiology of CAP was identified in 54% of the patients. C. burnetii represented 38.5% (106/275; 95% CI: 31.2–45.9%). In multivariate analysis, living in Cayenne area, being aged 30–60 years, C-reactive protein (CRP) > 185 mg/L, and leukocyte count < 10 G/L were independently associated with Q fever. The prevalence of Q fever among CAP increased to 38.5%. This is the highest prevalence ever reported in the world. This high prevalence justifies the systematic use of doxycycline in addition to antipneumococcal antibiotic regimens.