Abstract
STUDY OBJECTIVE
To determine the incidence and the clinical significance of two autoimmune markers in Q-fever (smooth muscle antibodies, cold agglutinins).
DESIGN
Six index cases with auto-immune disorders. Assays of 104 sera from patients with Q-fever (including index cases) using immunofluorescence for smooth muscle antibodies, microagglutination for cold agglutinins.
SETTING
French National Reference Center for Rickettsial Diseases.
CASES
6 patients were studied with acute Q-fever and auto-immune disorders. 3 of whom had presented a resistance to a therapy with antibiotics. Stored samples from other patients with acute or chronic stage were also screened to appreciate the incidence of the two markers.
MEASUREMENTS AND MAIN RESULTS
CASE REPORTS
No correlation between Q-fever and smooth muscle antibodies titers and kinetics were found. A spurt of corticosteroids was necessary to obtain apyrexia for the patients who had presented multiple auto-immune disorders and a resistance to the classical therapy. INCIDENCE; Smooth muscle antibodies were detected in 27%, cold agglutinins in one case. They were present in 23% of the patients with acute cases and in 38% with chronic stage.
CONCLUSION
The incidence of auto-immune disorders is unexpectedly high and could explain some manifestations of acute Q-fever e.g the resistance to therapy with antibiotics which are not yet clear. Then the association during the acute stage of auto-immune disorders with the persistence of clinical or biological findings after three weeks therapy could recommend the use of corticosteroids.
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