The first case of a patient suffering from C. burnetii infection committing suicide arising from a state of depression

Int Med J. 2012 Dec;19(4):312-313.

Yakubo S1), Ueda Y1), Arashima Y2), Nakayama T2), Komiya T 3), Kato K4)

1) Division of Integrated Herbal Medicine, Department of Medicine, Nihon University School of Medicine

2) Division of Laboratory Medicine, Department of Pathology and Microbiology, Nihon University School of Medicine

3) Research Center for Biologicals, The Kitasato Institute

4) Division of Gastroenterology and Hepatology, Nihon University School of Medicine

 

ABSTRACT

[introduction]Marmion et al. recently reported a new condition, post-Q fever fatigue syndrome (QFS), in which nonspecific symptoms such as a slight fever, general malaise, headache, arthralgia, and myalgia continue indefinitely after a Q fever infection with Coxiella burnetii (C. burnetii).

[case]We report the case of a 53-year-old male infected with C. burnetii, who complained of nausea, stomach pain, an abnormal sensation in the mouth, sore throat, general fatigue, and trouble sleeping, symptoms which suggested QFS. An evaluation with the self-rating depression scale led to the conclusion that the patient was in a depressive state, which can sometimes lead to suicide. In this case, the patient did indeed commit suicide in spite of treatment with an antidepressant as well as an antibiotic against the C. burnetti infection.

[conclusion]This report is the first case of a patient led to suicide due to depression arising from QFS.

 

SUPPLEMENT:

Acute infection with C. burnetii, the causative agent of Q fever, can produce influenza-like symptoms, pneumonia, and even liver dysfunction. It has been reported that this disorder responds to treatment with tetracycline antimicrobial agents and or New Quinolone, which show favorable outcomes.

However, symptoms of chronic Q fever include chronic hepatitis and endocarditis, and the condition tends to be resistant to treatment. Chemotherapy, even when continued for 2 to 3 years, in many cases fails to eradicate the bacteria (1). Marmion et al. in Australia recently reported a new condition, QFS, in which nonspecific symptoms such as a slight fever, general malaise, headache, arthralgia, and myalgia continue indefinitely after a Q fever infection (2). We were the first to report QFS in Japan (3).

C. burnetti causes a zoonosis, Q fever. It is carried by many animals, including wildlife, livestock, dogs, cats, birds, and ticks, and is common throughout the world. Q fever had until 1996 been thought absent from Japan, when it was confirmed in a patient with influenza-like symptoms (4). Subsequently, it has been confirmed that Q fever is not at all rare, being the fourth to sixth most common etiological factor for community-acquired pneumonia in Japan (5). However, it remains true in Japan that Q fever is not commonly recognized.

We earlier reported a 46-year-old male infected with Coxiella burnetii, complaining of slight fever, general fatigue, and trouble sleeping (6). His symptoms, including a depressive state that had resulted in thoughts of death, were relieved by three months of Minocycline therapy.

The mechanism by which C. burnetii infection leads to a depressive state is still unclear. However, a previous report has suggested that the cytokine network is affected, and that C. burnetii infection-related abnormalities in the cytokine network involving TNF may be involved in the mechanism underlying the onset of depression.

In this paper, we described a 53-year-old male with QFS, in whom the anti C. burnetii IgG antibody titers against the phase I antigen were 1:256. He suffered from depression, which ultimately led him to commit suicide.

His depressed state was not prolonged, and his physical condition did not appear to be particularly severe, and yet the depression triggered by the C. burnetii infection ultimately led to suicide. As far as we can ascertain, this is the first case of its kind.

This leads to the conclusion that, in cases of C. burnetii infection, in addition to treating the infection with antibiotics, it is also essential to evaluate fully any accompanying depression and if appropriate treat it aggressively. In the case in question, use of the self-rating depression scale (SDS, consisting of 20 questions, with scores per question of 1 to 4 points) allowed us to diagnose depression, and we would suggest that the SDS is a useful diagnostic tool in such case(7). It may also be advisable to consider involving a psychiatrist at an early stage of treatment.

We have described a case involving a male patient with a C. burnetti infection who committed suicide arising from a depressive state. The experience suggests that in such cases treatment needs to be planned with full consideration of the patient’s mental state, in addition to the QFS symptoms induced by the C. burnetii infection. In particular, it would seem to be essential to be aware of the danger of suicide arising from depression.

REFERENCES

1) Raoult D. Treatment of Q fever. Antimicrob Agents Chemother 37: 1733-1736,1993.

2) Marmion BP. Q fever. Your Questions Answered, MediMedia Communications: 9-16, 1999.

3) Kato K, Arashima Y, Asai S, et al. Detection of Coxiella burnetii species DNA in blood samples from Japanese patients with chronic nonspecific symptoms by nested polymerase chain reaction. FEMS Immunol Med Microbiol 21: 139-144,1998.

4) Nagaoka H, Akiyama M, Sugieda M, et al. Isolation of Coxiella burnetii from children with influenza-like symptoms in Japan. Microbiol Immunol 40: 147-51,1996.

5) Watanabe A. Diagnosis and treatment of Q fever: attempts to clarify current problems in Japan, J Infect Chemother.14: 1-7, 2008.

6) A patient in whom treatment for Coxiella burnetii infection ameliorated a depressive state and thoughts of impending death. Int Med J. 19:65-66, 2012

7) Zung WWK. A selfrating depression scale. Arch Gen Psychiatry 12:63-70,1965.

Contact

Shuji Yakubo,  M.D., Ph. D.

Associate Professor and Chair

Division of Integrated Herbal Medicine, Department of Medicine, Nihon University School of Medicine

30-1 Oyaguchi-kamimachi, Itabashi-ku, Tokyo 173-8610, Japan

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