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Coxiella burnetii (Q fever)

Etiologic agent of Q fever. Epidemiology: 1) shed in the urine, feces, milk & birth products of: a) sheep b) cattle c) goats d) cats 2) high bacterial levels in amniotic fluid of farm animals giving birth [4] 3) human infection acquired by inhalation of dried or aerosolized material 4) world-wide distribution - US military personnel returning from Iraq 5) ticks are reservoir 6) 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: 1) pneumonia 2) granulomatous hepatitis, cholangitis [11] - granulomatous inflammation & a fibrin-ring granuloma [11] 3) culture-negative endocarditis Clinical manifestations: 1) incubation period is 10-30 days 2) fever/chills 3) myalgias 4) nausea/vomiting 5) chest pain 6) cough (late manifestation) 7) jaundice, hepatomegaly [11] Laboratory: 1) leukocyte count is normal 2) serum transaminases may be elevated - serum alkaline phosphatase may be elevated [11] - serum bilirubin may be very elevated [11] - INR may be > 2 [11] 3) Coxiella burnetii serology: a) complement fixation (CF) positive titers > 1:8 - 65% positive in 2nd week, 90% in 4th week b) agglutination titers - positive after 5-8 days, > 90% positive within 14 days 4) Coxiella burnetii antigen 5) Coxiella burnetii identified by light microscopy 6) Coxiella burnetii DNA 7) see ARUP consult [8] Radiology: - chest X-ray: a) unilateral bronchopneumonia b) lobar consolidation (25%) c) 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 a) 18 months for native valves b) 24 months for prosthetic valves c) treatment should be extended only if serological evidence of Coxiella burnetii persists c) serological monitoring for 5 years because of risk of relapse [6]

Related

Q fever; Coxiella burnetii infection

General

Coxiella

Properties

KINGDOM: monera DIVISION: SCHIZOMYCETES

References

  1. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 798
  2. Clinical Guide to Laboratory Tests, 3rd ed. Teitz ed., W.B. Saunders, 1995
  3. Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 748
  4. Medical Knowledge Self Assessment Program (MKSAP) 15, 19 American College of Physicians, Philadelphia 2009, 2021
  5. 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
  6. 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: 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: 20637695 doi:10.1016/S1473-3099(10)70142-0 http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(10)70142-0/fulltext
  7. Million M et al Relapsing uveitis and optic neuritis due to chronic Q fever. Br J Ophthalmol. 2010 Aug 23. PMID: 20733024
  8. ARUP Consult: Coxiella burnetii - Q-Fever The Physician's Guide to Laboratory Test Selection & Interpretation https://www.arupconsult.com/content/coxiella-burnetii
  9. 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
  10. 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
  11. Geha R, Peters M, Gill RM, Dhaliwal G. Histology Rings True. N Engl J Med 2017; 376:869-874. March 2, 2017 PMID: 28249146 http://www.nejm.org/doi/full/10.1056/NEJMcps1609391
  12. Centers for Disease Control and Prevention (CDC) Q Fever: Information and Guidance for Clinicians http://www.bt.cdc.gov/agent/qfever/clinicians/index.asp