| Abstract | Cilj: Cilj rada bio je opisati kliničke i epidemiološke karakteristike Q groznice na području
Splitsko-dalmatinske županije u razdoblju od 1985. do 2010. godine, te upozoriti na važnost
pojave ove bolesti na ispitivanom području, radi što bolje dijagnostike i liječenja.
Ispitanici i metode: U radu je prikazano 229 bolesnika s akutnom Q groznicom koji su bili
hospitalizirani na Klinici za infektologiju u Kliničkom Bolničkom Centru Split , od 1985. do
2010. godine. Od ukupnog broja bolesnika, njih 216 bilo je iz Splitsko-dalmatinske županije,
a preostalih 13 iz susjednih županija. Korišteni podaci o epidemiologiji, znakovima i
simptomima bolesti uzeti su iz anketnih listića za bolesnike oboljelih od Q groznice.
Rezultati: Prosječna incidencija Q groznice u ispitivanom periodu na području Splitskodalmatinske
županije iznosila je 2.4/100.000 stanovnika. Općine Sinj i Primorski Dolac
bilježe najvišu godišnju incidenciju od >10/100.000 stanovnika dok na otocima i u priobalju
nije zabilježen niti jedan slučaj Q groznice. U 61,1 % slučajeva akutna Q groznica
prezentirala se kao pneumonija i hepatitis, u 25,3 % samo kao pneumonija, u 7,9 % samo kao
hepatitis i u 5,7 % slučajeva kao nespecifična febrilna bolest. U našem istraživanju najčešća
prezentacija Q groznice bila je pneumonija sa 86,4 % slučajeva i to kao pneumonija i
hepatitis (61,1 %) i sama pneumonija (25,3 %), dok je hepatitis utvrđen u 69,0 % bolesnika i
to kao pneumonija i hepatitis (61,1 %) i samo hepatitis (7,9 %). Od bolesnika s hepatitisom u
65,4 % slučajeva vrijednosti AST/ALT su bile do 3 puta više od normalne vrijednosti, a u
preostalih 34,6 % bolesnika, te vrijednosti su bile preko 3 puta više od normalne vrijednosti.
Najviša utvrđena vrijednost AST bila je 242 U/L, a ALT 383 U/L. Najčešći simptomi bili su
vrućica (94,8 %) i glavobolja (76,9 %).
Zaključak: Moguće da je broj bolesnika u kojih se Q groznica prezentira samo s hepatitisom,
ili kao nespecifično febrilno stanje na našem području i veći, ali često takva bolest ostane
neprepoznata. Stoga u bolesnika s naglim početkom bolesti, vrućicom i glavoboljom, koji su
boravili u ruralnom području i bili u kontaktu s domaćim životinjama (prvenstveno ovcama i
kozama), ako i nemaju klinički i rendgenski nalaz na plućima, treba napraviti jetrene enzime i
serološke pretrage na Q groznicu. Pretpostavlja se da bi se tada stekao uvid u stvarnu
incidenciju Q groznice na našem području. |
| Abstract (english) | Objectives: The aim of this study was to describe the clinical and epidemiological
characteristics of Q fever in County of Split-Dalmatia in the period since 1985. to 2010th
year, and show the importance of the appearance of the disease on the study area, in order to
better diagnosis and treatment.
Patients and Methods: This study describes 229 patients with acute Q fever who were
hospitalized in Clinical Hospital Center Split, from 1985. to 2010. Of all the patients, 216
were from the County of Split-Dalmatia, and 13 from neighbouring counties. The information
of the epidemiology, signs and symptoms of disease were taken from questionnaires for
patients with Q fever.
Results: The average incidence of Q fever in the study period in County of Split-Dalmatia
was 2.4/100.000 residents. Municipality of Sinj and Primorski Dolac recorded the highest
annual incidence of> 10/100.000 residents while on the islands and coastal areas has not been
a single case of Q fever. In 61.1 % of cases, acute Q fever presented as pneumonia and
hepatitis, in 25.3 % only as pneumonia, at 7.9 % only as hepatitis and in 5.7 % of cases as a
nonspecific febrile illness. In our study, the most common presentation of Q fever was
pneumonia with 86.4% of cases as pneumonia and hepatitis (61.1%) and pneumonia alone
(25.3%), while hepatitis identified in 69.0% of patients, as pneumonia and hepatitis (61.1%)
and only hepatitis (7.9 %). The AST/ALT value in 65.4 % of patients with hepatitis was
elevated up to 3 times the normal value, while AST/ALT in the remaining 34,6 % of patients
with hepatitis was more than 3 times the normal value. Highest value of AST was 242 U/L
and of ALT 383 U/L. The most common symptoms were fever (94.8%) and headache
(76.9%).
Conclusion: It is possible that the number of patients in whom the Q fever presented only
with hepatitis, or as a non-specific febrile conditions in our area is larger, but often such
disease remains unrecognized. Therefore, in patients with sudden onset of illness, fever and
headache, who lived in a rural area and were in contact with domestic animals (mainly sheep
and goats), even if they do not have a clinical and radiographic findings in the lungs, liver
enzymes and Q fever serology should be done. It can be assumed that this would give insight
into the actual Q-fever incidence in the region. |
