Coxiella burnetii (Q fever)
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Introduction
Epidemiology
- shed in the urine, feces, milk & birth products of:
- high bacterial levels in amniotic fluid of farm animals giving birth[4]
- human infection acquired by inhalation of dried or aerosolized material
- world-wide distribution
- US military personnel returning from Iraq
- ticks are reservoir
- an outbreak of Q fever in a group who traveled to Germany to receive IM injections of fetal sheep cells obtained from a flock of infected sheep in 2014[10]
Pathology
- pneumonia
- granulomatous hepatitis, cholangitis[11]
- granulomatous inflammation & a fibrin-ring granuloma[11]
- culture-negative endocarditis
Clinical manifestations
- incubation period is 10-30 days
- fever/chills
- myalgias
- nausea/vomiting
- chest pain
- cough (late manifestation)
- jaundice, hepatomegaly[11]
Laboratory
- leukocyte count is normal
- serum transaminases may be elevated
- serum alkaline phosphatase may be elevated[11]
- serum bilirubin may be very elevated[11]
- INR may be > 2[11]
- Coxiella burnetii serology:
- complement fixation (CF) positive titers > 1:8
- 65% positive in 2nd week, 90% in 4th week
- agglutination titers
- positive after 5-8 days, > 90% positive within 14 days
- complement fixation (CF) positive titers > 1:8
- Coxiella burnetii antigen
- Coxiella burnetii identified by light microscopy
- Coxiella burnetii DNA
- see ARUP consult[8]
Radiology
- chest X-ray:
- unilateral bronchopneumonia
- lobar consolidation (25%)
- small pleural effusions
Complications
- culture-negative endocarditis
- relapsing uveitis & optic neuritis due to chronic Q fever[7]
Management
- tetracycline, doxycycline
- alternative: macrolide
- endocarditis should be treated with doxycycline & hydroxychloroquine for a duration of
- 18 months for native valves
- 24 months for prosthetic valves
- treatment should be extended only if serological evidence of Coxiella burnetii persists
- serological monitoring for 5 years because of risk of relapse[6]
More general terms
Additional terms
References
- ↑ Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 798
- ↑ Clinical Guide to Laboratory Tests, 3rd ed. Teitz ed., W.B. Saunders, 1995
- ↑ Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 748
- ↑ Jump up to: 4.0 4.1 Medical Knowledge Self Assessment Program (MKSAP) 15, 19 American College of Physicians, Philadelphia 2009, 2021
- ↑ CDC Health Advisory, Wednesday, May 12, 2010 Potential for Q Fever Infection Among Travelers Returning from Iraq and the Netherlands http://www2a.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00313
- ↑ Jump up to: 6.0 6.1 Million M et al Long-term outcome of Q fever endocarditis: a 26-year personal survey The Lancet Infectious Diseases, Early Online Publication, 15 July 2010 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20637694 doi:10.1016/S1473-3099(10)70135-3 http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(10)70135-3/fulltext
Marrie TJ Q fever endocarditis The Lancet Infectious Diseases, Early Online Publication, 15 July 2010 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20637695 doi:10.1016/S1473-3099(10)70142-0 http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(10)70142-0/fulltext - ↑ Jump up to: 7.0 7.1 Million M et al Relapsing uveitis and optic neuritis due to chronic Q fever. Br J Ophthalmol. 2010 Aug 23. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20733024
- ↑ Jump up to: 8.0 8.1 ARUP Consult: Coxiella burnetii - Q-Fever The Physician's Guide to Laboratory Test Selection & Interpretation https://www.arupconsult.com/content/coxiella-burnetii
- ↑ Anderson A et al Centers for Disease Control and Prevention Diagnosis and Management of Q Fever - United States, 2013: Recommendations from CDC and the Q Fever Working Group. MMWR. Recommendations and Reports. March 29, 2013 / 62(RR03);1-23 http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6203a1.htm
- ↑ Jump up to: 10.0 10.1 Robyn MP et al Q Fever Outbreak Among Travelers to Germany Who Received Live Cell Therapy - United States and Canada, 2014. MMWR Weekly. October 2, 2015 / 64(38);1071-1073 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6438a3.htm
- ↑ Jump up to: 11.0 11.1 11.2 11.3 11.4 11.5 11.6 Geha R, Peters M, Gill RM, Dhaliwal G. Histology Rings True. N Engl J Med 2017; 376:869-874. March 2, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28249146 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMcps1609391
- ↑ Centers for Disease Control and Prevention (CDC) Q Fever: Information and Guidance for Clinicians http://www.bt.cdc.gov/agent/qfever/clinicians/index.asp