Clinical and epidemiological features of hospitalized acute Q fever cases from Split-Dalmatia County (Croatia), 1985-2002.
BACKGROUND
Q fever shows a wide diversity of clinical manifestation. Q fever is endemic in northern Croatia, but the epidemiological and clinical characteristics of this disease in various ecological areas of southern Croatia are unclear.


METHODS
From January 1985 to December 2002, acute Q fever cases hospitalized at Split University Hospital were analyzed. Acute Q fever was defined as fever (>38 degrees C) with clinical findings in lung and/or liver verified by serologic testing with Coxiella burnetii phase II antigen.


RESULTS
During the period of observation, 155 acute Q fever cases were hospitalized. The mean incidence of acute Q fever in the study region was 0.20/100,000/year (95%CI:0-0.78) in the coastal area and 4.64/100,000/year (95%CI:0.44-8.85) in the non-coastal areas, with a male predominance (chi2=60.0; p=0.0000) and a mean male to female ratio of 4.2:1. People of essentially all ages (4-76 years) were affected, the highest rate of infection being recorded in 20- to 49-year-old age groups. In contrast to adults, girls were more frequently affected than boys (2:1). No case of acute Q fever was recorded on any of the nearby islands. Clinically, acute Q fever most commonly presented with both pneumonia and hepatitis (60.0%), followed by pneumonia (25.8%), hepatitis (9.0%), and nonspecific febrile illnesses (5.2%).


CONCLUSIONS
C. burnetii is endemic in rural, coastal, and non-coastal areas of southern Croatia and is associated with stock breeding. In these areas, Q fever occurs sporadically and epidemically. Males 20-49 years of age were the prevalent cases.
Luksić
Boris
B
Department of Infectious Diseases, Split University Hospital, Split, Croatia. boris.luksic1@st.htnet.hr
Punda-Polić
Volga
V
Ivić
Ivo
I
Bradarić
Ivica
I
Bradarić
Nikola
N
D000208:Acute Disease; D017677:Age Distribution; D000907:Antibodies, Bacterial / Q000032:analysis; D016997:Coxiella burnetii / Q000276:immunology; D017523:Croatia / Q000453:epidemiology; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect; D005843:Geography; D006505:Hepatitis / Q000453:epidemiology / Q000382:microbiology; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008297:Male; D011022:Pneumonia, Rickettsial / Q000453:epidemiology / Q000382:microbiology; D015995:Prevalence; D011778:Q Fever / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology / Q000382:microbiology / Q000473:pathology*; D012189:Retrospective Studies; D012307:Risk Factors; D012621:Seasons; D016036:Seroepidemiologic Studies
D000907:Antibodies, Bacterial