Q fever: Difference between revisions
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==Background== | ==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== | ==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== | ==Differential Diagnosis== | ||
{{Fever in Traveler DDX}} | {{Fever in Traveler DDX}} | ||
== | {{Lower respiratory zoonotic infections}} | ||
==Evaluation== | |||
*CBC, Complete Metabolic Panel – Liver enzymes usually elevated 2-10 times normal | |||
*[[Blood cultures]] | |||
*[[CXR]] | |||
==Management== | ==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== | ==Disposition== | ||
*Most patients require admission for further workup | |||
==See Also== | ==See Also== | ||
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==External Links== | ==External Links== | ||
== | ==References== | ||
<references/> | <references/> | ||
*http://www.cdc.gov/qfever/ | |||
*http://www.ncbi.nlm.nih.gov/pubmed/16168313 | |||
[[Category:ID]] | [[Category:ID]] | ||
Latest revision as of 12:30, 9 September 2016
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
- Normal causes of acute fever!
- Malaria
- Dengue
- Leptospirosis
- Typhoid fever
- Typhus
- Viral hemorrhagic fevers
- Chikungunya
- Yellow fever
- Rift valley fever
- Q fever
- Amebiasis
- Zika virus
Lower Respiratory Zoonotic Infections
- Psittacosis
- Anthrax (Bacillus anthracis)
- Brucellosis (Brucella species)
- Q fever (C. burnetti)
- Pasteurellosis (Pasteurella multocida)
- Melioidosis (Burkholderia pseudomallei)
- Rocky Mountain Spotted Fever (R. rickettsii)
- Pulmonic Plague (Yersinia pestis)
- Influenza A
- Hantavirus
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