title: Persistent Q fever and ischaemic stroke in elderly patients.
abstract: Whether persistent or chronic Q fever may act as a risk factor for stroke is unknown. A case-control study was conducted in the Hospital Universitario de Burgos (Spain) between February 2011 and December 2012. A total of 803 samples from 634 consecutive hospitalized patients ≥65 years old were tested, of whom 111 were cases (patients with prevalent or incident ischaemic stroke and/or transient ischaemic attack) and 523 were controls (patients without ischaemic stroke and/or transient ischaemic attack). Immunoglobulin G (IgG) antibody titres phase I and II against Q fever, and IgG antibodies levels against Chlamydia pneumoniae and cytomegalovirus (CMV), were determined using immunofluorescence assay and ELISA methods, respectively. Phase I IgG titres against Coxiella burnetii ≥1:256 (compatible with chronic or persistent Q fever) were detected in 16 of 110 (14.5%) cases and in 32 of 524 (6.1%) controls; P = .004, odds ratio (OR) 2.6, 95% confidence interval (CI) 1.3 to 4.9. This ratio was maintained after adjusting for age, sex, hypertension, dyslipidaemia, cardioembolic focus, smoking, diabetes, other cardiovascular diseases, C-reactive protein, and leukocyte count (OR 2.6, 95% CI 1.3 to 5.3). High-titre IgG antibodies (top quartile) against CMV (OR 2.1, 95% CI 1.3 to 3.5), but not against C. pneumoniae (OR 0.9, 95% CI 0.5 to 1.6), also were associated with ischaemic stroke after adjustment for risk factors. In conclusion, serology compatible with persistent or chronic Q fever is associated with ischaemic stroke in elderly patients. High levels of IgG antibodies against CMV, but not against C. pneumoniae, also are associated with ischaemic stroke in these patients.
authors: Internal Medicine Department, Hospital Universitario de Burgos, Burgos, Spain. Electronic address: sgq414444@gmail.com.
authors: S
authors: S
authors: González-Quijada
authors: Internal Medicine Department, Hospital Universitario de Burgos, Burgos, Spain.
authors: E
authors: E
authors: Salazar-Thieroldt
authors: Department of Chest Diseases, Hospital Universitario de Burgos, Burgos, Spain.
authors: M J
authors: MJ
authors: Mora-Simón
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000907:Antibodies, Bacterial / Q000097:blood; D016022:Case-Control Studies; D016997:Coxiella burnetii / Q000276:immunology; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D008297:Male; D011778:Q Fever / Q000150:complications*; D013030:Spain / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology*
chemical_list: D000907:Antibodies, Bacterial; D007074:Immunoglobulin G
keywords: Cerebrovascular disease; Chlamydia penumoniae serology; Coxiella burnetii; Q fever; Q fever serology; cytomegalovirus serology; ischaemic stroke