贝氏柯克斯体感染,也称 Q 热,在大多数国家均有报道,但新西兰尚无病例报道。[6]Parker NR, Barralet JH, Bell AM. Q fever. Lancet. 2006;367:679-688.http://www.ncbi.nlm.nih.gov/pubmed/16503466?tool=bestpractice.com法国南部和西班牙发病率最高。[20]Raoult D, Tissot-Dupont H, Foucault C, et al. Q fever 1985-1998: clinical and epidemiologic features of 1,383 infections. Medicine. 2000;79:109-123.http://www.ncbi.nlm.nih.gov/pubmed/10771709?tool=bestpractice.com[21]Tissot-Dupont H, Raoult D, Brouqui P, et al. Epidemiologic features and clinical presentation of acute Q fever in hospitalized patients: 323 French cases. Am J Med. 1992;93:427-434.http://www.ncbi.nlm.nih.gov/pubmed/1415306?tool=bestpractice.com[22]Houpikian P, Habib G, Mesana T, et al. Changing clinical presentation of Q fever endocarditis. Clin Infect Dis. 2002;34:e28-e31.http://cid.oxfordjournals.org/content/34/5/e28.fullhttp://www.ncbi.nlm.nih.gov/pubmed/11807685?tool=bestpractice.com[23]Lepe JA, Guerrero FJ, Ruiz-Calderon A, et al. The epidemiology of Q fever in the northern area of Huelva, Spain. Enferm Infecc Microbiol Clin. 1999;17:65-68.http://www.ncbi.nlm.nih.gov/pubmed/10193064?tool=bestpractice.com该疾病在春季和初夏时频发。该疾病在澳大利亚流行与畜牧业和屠宰场密切相关。[6]Parker NR, Barralet JH, Bell AM. Q fever. Lancet. 2006;367:679-688.http://www.ncbi.nlm.nih.gov/pubmed/16503466?tool=bestpractice.com[24]Gidding HF, Wallace C, Lawrence GL, et al. Australia's national Q fever vaccination program. Vaccine. 2009;27:2037-2041.http://www.ncbi.nlm.nih.gov/pubmed/19428827?tool=bestpractice.com在美国,中西部的发病率高,但加利福尼亚州报告的病例总数最多。[25]Karakousis PC, Trucksis M, Dumler JS. Chronic Q fever in the United States. J Clin Microbiol. 2006;44:2283-2287.http://jcm.asm.org/content/44/6/2283.fullhttp://www.ncbi.nlm.nih.gov/pubmed/16757641?tool=bestpractice.com据记载,迄今为止最大的爆发于 2007 至 2009 年之间发生于荷兰,报告了 4,000 多例。[26]Limonard GJ, Peters JB, Nabuurs-Franssen MH, et al. Detailed analysis of health status of Q fever patients 1 year after the first Dutch outbreak: a case-control study. QJM. 2010;103:953-958.http://qjmed.oxfordjournals.org/content/103/12/953.longhttp://www.ncbi.nlm.nih.gov/pubmed/20802011?tool=bestpractice.com[27]Morroy G, Peters JB, van Nieuwenhof M, et al. The health status of Q-fever patients after long-term follow-up. BMC Infect Dis. 2011;11:97.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3110112/http://www.ncbi.nlm.nih.gov/pubmed/21501483?tool=bestpractice.com[28]Van Steenbergen JE, Morroy G, Groot CA, et al. An outbreak of Q fever in The Netherlands - possible link to goats. Ned Tijdschr Geneeskd. 2007;151:1998-2003.http://www.ncbi.nlm.nih.gov/pubmed/17953175?tool=bestpractice.com[29]Klaassen CH, Nabuurs-Franssen MH, Tilburg JJ, et al. Multigenotype Q fever outbreak, the Netherlands. Emerg Infect Dis. 2009;15:613-614.http://wwwnc.cdc.gov/eid/article/15/4/08-1612_article.htmhttp://www.ncbi.nlm.nih.gov/pubmed/19331749?tool=bestpractice.com[30]Voelker R. Risk of exposure to Q fever pathogen boosted by travel in Iraq or Netherlands. JAMA. 2010;303:2345.http://www.ncbi.nlm.nih.gov/pubmed/20551401?tool=bestpractice.com爆发主要局限于该国南部,奶山羊被认为是传染源。最近,以色列(包括一次学校爆发[31]Amitai Z, Bromberg M, Bernstein M, et al. A large Q fever outbreak in an urban school in central Israel. Clin Infect Dis. 2010;50:1433-1438.http://www.ncbi.nlm.nih.gov/pubmed/20415568?tool=bestpractice.com)和台湾地区报告了聚集性病例。[32]Ergas D, Keysari A, Edelstein V, et al. Acute Q fever in Israel: clinical and laboratory study of 100 hospitalized patients. Isr Med Assoc J. 2006;8:337-341.http://www.ima.org.il/FilesUpload/IMAJ/0/48/24106.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/16805234?tool=bestpractice.com[33]Lai CH, Huang CK, Chin C. Acute Q fever: an emerging and endemic disease in southern Taiwan. Scand J Infect Dis. 2008;40:105-110.http://www.ncbi.nlm.nih.gov/pubmed/17852909?tool=bestpractice.com贝氏柯克斯体感染也在从伊拉克和阿富汗返回的美军人员中发现。[34]Gleeson TD, Decker CF, Johnson MD, et al. Q fever in US military returning from Iraq. Am J Med. 2007;120:e11-e12.http://www.amjmed.com/article/S0002-9343(07)00416-0/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/17765028?tool=bestpractice.com[35]Anderson AD, Baker TR, Littrell AC, et al. Seroepidemiologic survey for Coxiella burnetii among hospitalized US troops deployed to Iraq. Zoonoses Public Health. 2011;58:276-283.http://www.ncbi.nlm.nih.gov/pubmed/20880090?tool=bestpractice.com此外,近期从热带和澳大利亚返回的游客中也有感染病例报道。[36]Ta TH, Jiménez B, Navarro M, et al. Q fever in returned febrile travelers. J Travel Med. 2008;15:126-129.http://onlinelibrary.wiley.com/doi/10.1111/j.1708-8305.2008.00191.x/fullhttp://www.ncbi.nlm.nih.gov/pubmed/18346248?tool=bestpractice.com[37]Cohen NJ, Papernik M, Singleton J, et al. Q fever in an American tourist returned from Australia. Travel Med Infect Dis. 2007;5:194-195.http://www.ncbi.nlm.nih.gov/pubmed/17448948?tool=bestpractice.com尽管该病主要是一种人畜共患病,人与人之间的传播罕见,但已有性传播的病例报道。[38]Milazzo A, Hall R, Storm PA, et al. Sexually transmitted Q fever. Clin Infect Dis. 2001;33:399-402.http://cid.oxfordjournals.org/content/33/3/399.fullhttp://www.ncbi.nlm.nih.gov/pubmed/11438911?tool=bestpractice.com在极少数情况下,经输血传播。[39]Pantanowitz L, Telford SR, Cannon ME. Tick-borne diseases in transfusion medicine. Transfus Med. 2002;12:85-106.http://www.ncbi.nlm.nih.gov/pubmed/11982962?tool=bestpractice.com
农民、兽医、屠宰场工人实验室工作人员也存在感染风险。[40]Hall CJ, Richmond SJ, Caul EO, et al. Laboratory outbreak of Q fever acquired from sheep. Lancet. 1982;1:1004-1006.http://www.ncbi.nlm.nih.gov/pubmed/6122819?tool=bestpractice.com[41]Meiklejohn G, Reimer LG, Graves PS, et al. Cryptic epidemic of Q fever in a medical school. J Infect Dis. 1981;144:107-113.http://www.ncbi.nlm.nih.gov/pubmed/7276623?tool=bestpractice.com贝氏柯克斯体感染是第二常见的实验室报告感染。有报到在某些机构的疫情暴发涉及15例或更多的人。该疾病没有种族差异,但在男性中发病更为常见。[6]Parker NR, Barralet JH, Bell AM. Q fever. Lancet. 2006;367:679-688.http://www.ncbi.nlm.nih.gov/pubmed/16503466?tool=bestpractice.com在澳大利亚,男性患患者数是女性的5倍,在法国约2.5倍。这可能与男性职业暴露机会更大和女性17β-雌二醇的保护作用相关。[6]Parker NR, Barralet JH, Bell AM. Q fever. Lancet. 2006;367:679-688.http://www.ncbi.nlm.nih.gov/pubmed/16503466?tool=bestpractice.com[42]Leone M, Honstettre A, Lepidi H, et al. Effect of sex on Coxiella burnetii infection: protective role of 17beta-estradiol. J Infect Dis. 2004;189:339-345.http://jid.oxfordjournals.org/content/189/2/339.fullhttp://www.ncbi.nlm.nih.gov/pubmed/14722900?tool=bestpractice.com该疾病在儿童中罕见,大多数患者年龄超过 15 岁;[22]Houpikian P, Habib G, Mesana T, et al. Changing clinical presentation of Q fever endocarditis. Clin Infect Dis. 2002;34:e28-e31.http://cid.oxfordjournals.org/content/34/5/e28.fullhttp://www.ncbi.nlm.nih.gov/pubmed/11807685?tool=bestpractice.com在 30-70 岁之间的人群中最为普遍。[21]Tissot-Dupont H, Raoult D, Brouqui P, et al. Epidemiologic features and clinical presentation of acute Q fever in hospitalized patients: 323 French cases. Am J Med. 1992;93:427-434.http://www.ncbi.nlm.nih.gov/pubmed/1415306?tool=bestpractice.com[22]Houpikian P, Habib G, Mesana T, et al. Changing clinical presentation of Q fever endocarditis. Clin Infect Dis. 2002;34:e28-e31.http://cid.oxfordjournals.org/content/34/5/e28.fullhttp://www.ncbi.nlm.nih.gov/pubmed/11807685?tool=bestpractice.com