Q fever

Background

  • Described in 1937: occupational disease of abattoir workers (manage animals before and after slaughtering process) and dairy farmers
  • Caused by Coxiella burnetii
    • Obligate intracellular bacteria morphologically similar to Rickettsia
    • Reservoirs include cattle, goat, sheep, and ticks (Dermacentor andersoni)
  • CDC: category B biologic warfare agent due to its inhaled infectivity
  • Worldwide disease

Clinical Features

  • Symptoms usually develop within 2-3 weeks, although up to half of those infected may not show symptoms
    • high fevers (up to 104-105°F)
    • severe headache
    • general malaise
    • myalgias
    • chills/sweats
    • non-productive cough
    • nausea/vomiting
    • diarrhea
    • abdominal pain
    • chest pain
  • Complications include pneumonia, granulomatous hepatitis (inflammation of the liver), myocarditis (inflammation of the heart tissue), and central nervous system complications.
  • Endocarditis is the major form of chronic disease
  • Infection in pregnancy is more likely to be asymptomatic, but often results in chronic Q fever and obstetrical complications

Differential Diagnosis

Fever in traveler

Lower Respiratory Zoonotic Infections

Evaluation

  • CBC, Complete Metabolic Panel – Liver enzymes usually elevated 2-10 times normal
  • Blood cultures
  • CXR

Management

  • Doxycycline
    • Adults: 100mg BID
    • Children < 45 kg: 2.2mg/kg BID
  • Patients should be treated for at least 3 days after the fever subsides and until there is evidence of clinical improvement. Standard duration of treatment is 2-3 weeks.

Disposition

  • Most patients require admission for further workup

References

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