Coxiella Burnetti

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Contents 1 Introduction 2 Epidemiology 3 Pathology 4 Clinical-manifestations 5 Laboratory 6 Radiology 7 Complications 8 Management 9 More General Terms 10 References

Introduction

• Etiologic agent of Q fever.

Epidemiology

• shed in the urine, feces, milk & birth products of:

• sheep
• cattle
• goats
• cats

• human infection acquired by inhalation of dried or aerosolized material
• world-wide distribution

• US military personnel returning from Iraq

• ticks are reservoir

Pathology

• pneumonia
• hepatitis
• endocarditis

Clinical-manifestations

• incubation period is 10-30 days
• fever/ chills
• myalgias
• nausea/vomiting
• chest pain
• cough (late manifestation)

Laboratory

• leukocyte count is normal
• serum transaminases may be elevated
• 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

Radiology

• chest X-ray:

• unilateral bronchopneumonia
• lobar consolidation (25%)
• small pleural effusions

Complications

• endocarditis
• relapsing uveitis & optic neuritis due to chronic Q fever [7]

Management

• tetracycline
• 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 burnetti persists
• serological monitoring for 5 years because of risk of relapse [6]

More General Terms

• Coxiella

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, American College of Physicians, Philadelphia 2009
5. CDC Health Advisory, Wednesday, May 12, 2010 Potential for Q Fever Infection Among Travelers Returning from Iraq and the Netherlands [1]
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: [2] doi:10.1016/S1473-3099(10)70135-3 [3]
   - Marrie TJ Q fever endocarditis The Lancet Infectious Diseases, Early Online Publication, 15 July 2010 PMID: [4] doi:10.1016/S1473-3099(10)70142-0 [5]
7. Million M et al Relapsing uveitis and optic neuritis due to chronic Q fever. Br J Ophthalmol. 2010 Aug 23. PMID: &dopt=Abstract
8. Centers for Disease Control and Prevention (CDC) Q Fever: Information and Guidance for Clinicians [6]

Coxiella burnetti (Q fever)