Table 2. Main data obtained from the studies included in the systematic review.
| STUDY Location | DATE | N | SERIES | CLINICAL PRESENTATION | SYMPTOMS | ENVIRONMENT | RISK FACTORS | BIOCHEMICAL DATA | EVOLUTION |
|---|---|---|---|---|---|---|---|---|---|
|
Hellín et al.[9] Madrid |
Sept 1977—Aug 1980 | 23 | Sporadic | Isolated fever: 14 (61) Pneumonia: 9 (39) |
Fever: 23 (100) Headache: 18 (78) Myalgia: 14 (61) Respiratory symptoms: 13 (56) |
ND | Animal (livestock) or food exposure: 9 (39) | Transaminase: 17 (74) Leukopenia: 10 (43) Leukocytosis: 2 (9) |
Deceased: 0 (0) Chronic: 0 (0) |
|
Montejo-Baranda et al.[7] Vizcaya |
June 1981- June 1982 | 11 | Sporadic | Pneumonia: 10 (91) Isolated fever: 1 (9) |
Fever: 11 (100) Headache: 11 (11) Myalgia: 11 (100) |
Urban: 6 (54) Rural: 5 (46) |
Non-specific: 4 (36) | Transaminase: 7 (64) Leukopenia: 5 (36) |
Deceased: 0 (0) Chronic: 0 (0) |
|
Aguirre-Errasti et al.[10] Vizcaya |
March—May 1982 | 42 | Epidemic | Pneumonia: 28 (67) Hepatitis: 11 (26) |
Fever: 42 (100) Headache: 42 (100) Myalgia: 42 (100) |
ND | ND | Transaminase: 16 (38) | Chronic: 0 (0) Deceased: 0 (0) |
|
Menéndez-Caro et al.[11] Madrid |
1982–1983 | 26 | Sporadic | Isolated fever: 22 (85) Pneumonia: 3 (11) Endocarditis: 1 (4) |
Fever: 26 (100) Headache: 18 (69) Asthenia: 16 (61) Chills: 11 (42) Sweating: 8 (31) Cough: 7 (27) |
ND | Food exposure: 4 (15) Animal exposure (livestock): 2 (8) |
Transaminase: 15 (58) ESR: 8 (31) Leukocytosis: 7 (27) Leukopenia: 7 (27) |
Deceased: 1 (4) Chronic: 3 (11) |
|
Fernández-Roblas et al.[12] Madrid |
1982–1984 | 37 | Sporadic | Isolated fever: 28 (75) Pneumonia: 8 (22) Hepatitis: 1 (3) |
Fever: 37 (100) Headache: 27 (73) Chills: 20 (54) Respiratory symptoms: 18 (49) Arthromyalgia: 14 (38) |
ND | Non-specific: 12 (32) | Transaminase: 21 (57) Leukopenia: 5 (13.5) |
Deceased: 0 (0) Chronic: 5 (13.5) |
|
Sobradillo et al.[13] Vizcaya |
Jul 1982—Dec 1986 | 164 | Sporadic | Pneumonia: 164 (100) | Fever: 158 (96) Headache: 91 (55) Myalgia: 88 (54) Cough 88 (54) Chest pain: 56 (34) |
Urban: 89 (54) Rural: 75 (46) |
Animal exposure (ND): 13 (8) | Transaminase: 74 (45) ESR: 71 (43) Leukocytosis: 22 (13) |
Deceased: 0 (0) Chronic: 0 (0) |
|
De Alarcón et al.[8] Seville |
1983–1999 | 231 | Sporadic | Hepatitis: 148 (64) Isolated fever: 75 (32) Pneumonia: 3 (1) |
Fever: 231 (100) Chills: 174 (75) Headache: 172 (74.5) Myalgia: 158 (68) Arthralgia: 139 (60) Cough: 41 (18) |
Urban: 123 (53) Rural: 108 (47) |
Animal exposure (ND): 91 (39) Food exposure: 46 (20) Rural stay: 19 (15) |
Transaminase: 139 (60) Thrombocytosis: 43 (19) Thrombopenia: 41 (18) Leukopenia: 23 (10) Leukocytosis: 16 (7) |
Chronic: 0 (0) Deceased: 0 (0) |
|
Martínez-Luengas et al.[14] Seville |
Sept 1983—Oct 1984 | 34 | Sporadic | Pneumonia: 11 (32) Isolated fever: 22 (65) |
Fever: 34 (100) Headache: 32 (94) Arthromyalgia: 31 (91) |
ND | Non-specific: 20 (59) | Transaminase: 17 (50) ESR: 14 (41) Leukocytosis: 5 (15) |
Chronic: 1 (3) Deceased: 0 (0) |
|
Merino et al.[15] Soria |
Jan 1984—Dec 1996 | 13 | Sporadic | Pneumonia: 10 (77) Isolated fever: 1 (8) Hepatitis: 1 (8) |
Fever: 13 (100) Cough: 4 (31) Headache: 3 (23) |
ND | Animal exposure (ND): 2 (16) | ND | Chronic: 1 (8) Deceased: 0 (0) |
|
Domingo et al.[16] Barcelona |
Jan 1985—Dec 1997 | 63 | Sporadic | Hepatitis: 30 (48) Pneumonia: 26 (41) Isolated fever: 7 (11) |
Fever: 63 (100) | Urban: 63 (100) | Animal exposure (pets): 30 (48) | ND | Deceased: 0 (0) Chronic: 0 (0) |
|
Antón-Aranda et al.[17] Guipúzcoa |
1985–1989 | 60 | Sporadic | Pneumonia: 44 (73) Hepatitis: 17 (28) Isolated fever: 7 (12) |
Fever: 60 (100) Arthromyalgia: 38 (63) Cough: 33 (55) Headache: 32 (53) |
ND | Animal (livestock) or food exposure: 10 (17) | Transaminase: 28 (47) ESR: 17 (28) LDH: 11 (18) Leukocytosis: 11 (18) Thrombopenia: 11 (18) |
Deceased: 0 (0) Chronic: 1 (2) |
|
Millán-Mon et al.[18] La Palma Canary Islands |
1986–1988 | 35 | Sporadic | Isolated fever: 26 (74) Hepatitis: 7 (20) Pneumonia: 2 (6) |
Fever: 35 (100) Headache: 16 (46) Cough: 9 (26) Arthromyalgia: 13 (37) |
ND | Animal exposure (goats): 18 (51) | Transaminase: 31 (88) ESR: 27 (77) Leukocytosis: 9 (26) |
ND |
|
Romero-Jiménez et al.[19] Huelva |
1987–1999 | 109 | Sporadic | Hepatitis: 60 (55) Isolated fever: 47 (43) |
Fever: 106 (97) Headache: 83 (76) Arthromyalgia: 48 (44) |
Urban: 10 (9) Rural: 99 (91) |
Animal exposure (ND): 57 (52) | Leukopenia: 36 (33) Thrombopenia: 28 (26) |
ND |
|
Abad et al.[20] Vizcaya |
Jan 1988—Jan 1998 | 73 | Sporadic | Pneumonia: 55 (75) Isolated fever: 18 (25) |
Fever: 73 (100) Headache: 33 (45) Cough: 30 (41) |
ND | Non-specific: 11 (15) | Transaminase: 33 (45) Leukocytosis: 5 (7) |
Deceased: 0 (0) Chronic: 0 (0) |
|
Rotaeche del Campo et al.[21] Guipúzcoa |
Feb 1989 | 5 | Epidemic | Pneumonia: 3 (60) Isolated fever: 2 (40) |
Fever: 5 (100) Myalgia: 5 (100) Headache: 4 |
Rural: 5 (100) | Animal exposure (ND): 5 (100) | ESR: 3 (60) Transaminase: 2 (40) |
ND |
|
Bella et al.[22] Barcelona |
1989 | 17 | Sporadic | Pneumonia: 4 (23) Hepatitis: 12 (71) Isolated fever: 1 (6) |
Fever: 17 (100) | Urban: 17 (100) | ND | Transaminase: 14 (82) | ND |
|
Sampere et al.[23] Barcelona |
1989–1999 | 66 | Sporadic | Pneumonia: 37 (56) Hepatitis: 22 (33) Isolated fever: 5 (7.5) Pleuropericarditis: 1 (1.5) Bronchitis: 1 (1.5) |
Fever: 52 (79) Headache: 28 (42) Arthromyalgia: 27 (41) |
Urban: 66 (100) | Animal exposure (ND): 24 (36) Rural stay: 8 (12) |
Transaminase: 40 (61) Cholestasis: 29 (44) |
Deceased: 0 (0) Chronic: ND |
|
Martínez-Eizaguirre et al.[24] Guipúzcoa |
April—June 1990 | 30 | Epidemic | Isolated fever: 30 (100) | Fever: 30 (100) Sweating: 29 (97) Headache: 26 (87) Chills: 25 (83) Myalgia: 22 (73) |
Rural: 30 (100) | ND | Transaminase: 26 (86) ESR: 5 (17) Leukocytosis: 4 (13) Leukopenia: 4 (13) |
Deceased: 0 (0) Chronic: ND |
|
Pascual-Velasco et al.[25] Lanzarote Canary Islands |
1991–1992 | 94 | Sporadic | Pneumonia: 52 (55) Isolated fever: 42 (45) |
ND | ND | Animal exposure (goats): 25 (27) | ND | ND |
|
Muñoz-Sanz et al.[26] Badajoz |
June 1992—May 2005 | 124 | Sporadic | Isolated fever: 64 (52) Hepatitis: 53 (43) Pneumonia: 14 (11) Endocarditis: 7 (6) |
Fever: 120 (97) Headache: 40 (32) |
Urban: 48 (39) Rural: 76 (61) |
Animal exposure (sheep, goats and cows): 58 (47) | ND | Deceased: 0 (0) Chronic: 7 (6) |
|
Espejo et al.[27] Canary Islands—La Rioja—Catalonia |
1995–2009 (Canary Islands 2005–2009) | 183 | Sporadic | Hepatitis: 90 (49) Isolated fever: 58 (32) Pneumonia: 35 (19) |
Headache: 107 (58.5) Arthromyalgia: 69 (38) Nausea/vomiting: 32 (17.5) |
Urban: 120 (65.5) Rural: 63 (34.5) |
ND | ND | Deceased: 2 (1) Chronic: ND |
|
Nuño-Mateo et al.[28] Asturias |
Feb 1996—May 2001 | 12 | Sporadic | Pneumonia: 10 (83) Isolated fever: 2 (17) |
Headache: 12 (100) Fever: 12 (100) Cough: 8 (66) |
Rural: 3 (25) Urban: 9 (75) |
Animal exposure (sheep and cattle): 5 (42) | Transaminase: 11 (90) ESR: 11 (90) |
Deceased: 0 (0) Chronic: 0 (0) |
|
Lepe et al.[29] Huelva |
1996–1997 | 21 | Sporadic | Isolated fever: 19 (90) Pneumonia: 2 (10) |
Fever: 21 (100) Headache: 21 (100) Myalgia: 21 (100) |
ND | Animal exposure (ND): 9 (43) | Transaminase: 21 (100) | Deceased: 0 (0) Chronic: 0 (0) |
|
Bartolomé et al.[30] Albacete |
April 1997—Sept 2002 | 35 | Sporadic | Hepatitis: 17 (48) Pneumonia: 9 (26) Isolated fever: 8 (23) Myocarditis: 1 (3) |
Fever: 34 (95) Headache: 16 (46) Arthromyalgia: 13 (37) Cough: 12 (34) |
Urban: 25 (71.5) Rural: 10 (28.5) |
Animal exposure (livestock): 9 (26) Rural stay: 5 (14) |
Transaminase: 26 (74) ESR: 14 (40) |
Deceased: 1 (3) Chronic: ND |
|
Nebreda et al.[31] Soria |
May 1998 | 14 | Epidemic | Pneumonia: 9 (64) Isolated fever: 5 (36) |
Fever: 13 (93) Headache: 10 (71) Sweating: 8 (57) Myalgia: 5 (36) |
Rural: 14 (100) | Animal exposure (ND): 3 (21) Food exposure: 1 (7) Rural stay: 2 (14) |
Leukopenia: 2 (14) | Chronic: 0 (0) Deceased: 0 (0) |
|
Bolaños et al.[32] Gran Canaria Canary Islands |
1998–2000 | 59 | Sporadic | Hepatitis: 52 (88) Pneumonia: 7 (12) Isolated fever: 3 (5) |
Fever: 59 (100) |
Urban: 32 (54) Rural: 27 (46) |
Animal exposure (ND): 15 (25) | Transaminase: 52 (88) APTT: 26 (44) |
Deceased: 1 (2) Chronic: 0 (0) |
|
Martín-Aspas et al.[33] Cádiz |
2000–2010 | 80 | Sporadic | Hepatitis: 50 (63) Isolated fever: 16 (20) |
Fever: 78 (98) | Urban: 69 (86) Rural: 11 (14) |
ND | Transaminase: 43 (54) Thrombocytopenia: 39 (49) |
Deceased: ND Chronic: 16 (20)* |
|
Ramos et al.[4] Alicante |
Jan 2001—Sept 2004 | 30 | Sporadic | Hepatitis: 21 (70) Isolated fever: 5 (17) Pneumonia: 3 (10) Meningo-encephalitis: 1 (3) |
Fever: 30 (100) Headache: 29 (97) Myalgia: 25 (83) |
Urban: 20 (67) Rural: 10 (33) |
Animal exposure (ND): 16 (53) | CRP: 29 (97) Transaminase: 20 (67) ESR: 19 (63) LDH: 17 (51.5) APTT: 12 (36) |
Deceased: 0 (0) Chronic: ND |
|
Ruiz-Seco et al.[34] Madrid |
2001–2008 | 54 | Sporadic | Pneumonia: 29 (54) Hepatitis: 13 (24) Isolated fever: 13 (24) |
Fever: 37 (68) Cough: 25 (47) Breathless: 13 (25) |
Urban: 28 (52) Rural: 26 (48) |
Animal exposure (ND): 32 (59) | ESR: 37 (72) Leukopenia: (60) Thrombocytosis: (60) |
Chronic: 3 (8) Deceased: 3 (8) |
|
García-Clemente et al.[35] Asturias |
Jan/Feb 2003 | 60 | Epidemic | Pneumonia: 60 (100) | Fever: 60 (100) Headache: 48 (80) Myalgia: 46 (77) Cough: 42 (70) |
Rural: 29 (48) Urban: 31 (52) |
Animal exposure (livestock): 4 (7) | Transaminase: 21 (35) APTT: 14 (24) |
Deceased: 0 (0) Chronic: 0 (0) |
|
Raya-Cruz et al.[36] Mallorca Balearic Islands |
March 2003—Feb 2011 | 87 | Sporadic | Pneumonia: 39 (45) Isolated fever: 21 (24) Hepatitis: 19 (22) Pericarditis: 3 (3.5) Meningitis: 1 (1) Meningo-encephalitis: 1 (1) |
Fever: 62 (71) Cough: 32 (37) Headache: 23 (26) Breathless: 15 (17) |
Urban: 35 (40) Rural: 39 (45) Undefined: 13 (15) |
Animal exposure (cattle, sheep and goats): 8 (9) Urban animal exposure (pets): 31 (36) Food exposure: 1 (1) |
Leukocytosis: 27 (31) Transaminase: 29 (33) |
Chronic: 1 (1) Deceased: 3 (3.4) |
|
De los Ríos-Martín et al.[37] Madrid |
Feb—March 2004 | 16 | Epidemic | Isolated fever: 14 (87.5) Pneumonia: 2 (12.5) |
Fever: 16 (100) Anorexia: 13 (81) Asthenia: 11 (69) Cough: 9 (56) |
ND | Animal exposure (ND): 16 (100) | Transaminase: 2 (12.5) Thrombopenia: 2 (12.5) |
ND |
|
Alonso et al.[38] Vizcaya |
Feb—April 2014 | 50 | Epidemic | Isolated fever: 14 (28) Pneumonia: 13 (26) |
Fever: 27 (54) Headache: 22 (44) Myalgia: 11 (22) |
Urban: 44 (88) Rural: 6 (12) |
Animal exposure (livestock): 3 (6) | ND | Chronic: 0 (0) Deceased: 0 (0) |
Data are shown as absolute values (percentage).
* All patients diagnosed with chronic Q fever on the basis of biochemical criteria alone.
CRP: C reactive protein; ESR: erythrocyte sedimentation rate; LDH: lactate dehydrogenase; APTT: activated partial thromboplastin time; ND: no data.