title: Circulating cytokines and procalcitonin in acute Q fever granulomatous hepatitis with poor response to antibiotic and short-course steroid therapy: a case report.
abstract: BACKGROUND
  Q fever is a zoonosis distributed worldwide that is caused by Coxiella burnetii infection and the defervescence usually occurs within few days of appropriate antibiotic therapy. Whether the changes of cytokine levels are associated with acute Q fever with persistent fever despite antibiotic therapy had not been investigated before.
  
  
  METHODS
  We report a rare case of acute Q fever granulomatous hepatitis remained pyrexia despite several antibiotic therapy and 6-day course of oral prednisolone. During the 18-month follow-up, the investigation of the serum cytokines profile and procalcitonin (PCT) revealed that initially elevated levels of interleukin-2 (IL-2), IL-8, IL-10, and PCT decreased gradually, but the IL-6 remained in low titer. No evidence of chronic Q fever was identified by examinations of serum antibodies against C. burnetii and echocardiography.
  
  
  CONCLUSIONS
  The changes of cytokine levels may be associated with acute Q fever with poor response to treatment and PCT may be an indicator for monitoring the response to treatment.
authors.affiliation: Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung County, Taiwan.
authors.forename: Chung-Hsu
authors.initials: CH
authors.lastname: Lai
authors.forename: Jiun-Nong
authors.initials: JN
authors.lastname: Lin
authors.forename: Lin-Li
authors.initials: LL
authors.lastname: Chang
authors.forename: Yen-Hsu
authors.initials: YH
authors.lastname: Chen
authors.forename: Hsi-Hsun
authors.initials: HH
authors.lastname: Lin
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000907:Antibodies, Bacterial / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D016997:Coxiella burnetii / Q000276:immunology; D016207:Cytokines / Q000097:blood*; D006105:Granulomatous Disease, Chronic / Q000188:drug therapy / Q000276:immunology* / Q000473:pathology; D006505:Hepatitis / Q000188:drug therapy / Q000276:immunology* / Q000473:pathology; D006801:Humans; D008297:Male; D011239:Prednisolone / Q000627:therapeutic use*; D011498:Protein Precursors / Q000097:blood*; D011778:Q Fever / Q000150:complications* / Q000188:drug therapy / Q000276:immunology / Q000473:pathology
chemical_list: D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D000907:Antibodies, Bacterial; C000606589:CALCA protein, human; D016207:Cytokines; D011498:Protein Precursors; D002116:Calcitonin; D011239:Prednisolone; D015740:Calcitonin Gene-Related Peptide