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 | *Described in 1937: occupational disease of abattoir workers (manage animals before and after slaughtering process) and dairy farmers | ||
* Caused by Coxiella burnetii | *Caused by Coxiella burnetii | ||
** Obligate intracellular bacteria morphologically similar to Rickettsia | **Obligate intracellular bacteria morphologically similar to Rickettsia | ||
** Reservoirs include cattle, goat, sheep, and ticks (Dermacentor andersoni) | **Reservoirs include cattle, goat, sheep, and ticks (Dermacentor andersoni) | ||
* CDC: category B biologic warfare agent due to its inhaled infectivity | *CDC: category B biologic warfare agent due to its inhaled infectivity | ||
* Worldwide disease | *Worldwide disease | ||
==Clinical Features== | ==Clinical Features== | ||
* Symptoms usually develop within 2-3 weeks, although up to half of those infected may not show symptoms | *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) | **high [[fevers]] (up to 104-105°F) | ||
** severe [[headache]] | **severe [[headache]] | ||
** general malaise | **general malaise | ||
** myalgias | **myalgias | ||
** chills/sweats | **chills/sweats | ||
** non-productive cough | **non-productive cough | ||
** [[nausea/vomiting]] | **[[nausea/vomiting]] | ||
** [[diarrhea]] | **[[diarrhea]] | ||
** [[abdominal pain]] | **[[abdominal pain]] | ||
** [[chest pain]] | **[[chest pain]] | ||
* Complications include [[pneumonia]], granulomatous hepatitis (inflammation of the liver), [[myocarditis]] (inflammation of the heart tissue), and central nervous system complications. | *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 | *[[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 | *Infection in pregnancy is more likely to be asymptomatic, but often results in chronic Q fever and obstetrical complications | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Diagnosis== | ==Diagnosis== | ||
* CBC, Complete Metabolic Panel – Liver enzymes usually elevated 2-10 times normal | *CBC, Complete Metabolic Panel – Liver enzymes usually elevated 2-10 times normal | ||
* [[Blood cultures]] | *[[Blood cultures]] | ||
* CXR | *CXR | ||
==Management== | ==Management== | ||
* [[Doxycycline]] | *[[Doxycycline]] | ||
** Adults: 100 mg BID | **Adults: 100 mg BID | ||
** Children < 45 kg: 2.2 mg/kg BID | **Children < 45 kg: 2.2 mg/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. | *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== | ||
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==References== | ==References== | ||
<references/> | <references/> | ||
* http://www.cdc.gov/qfever/ | *http://www.cdc.gov/qfever/ | ||
* http://www.ncbi.nlm.nih.gov/pubmed/16168313 | *http://www.ncbi.nlm.nih.gov/pubmed/16168313 | ||
[[Category:ID]] | [[Category:ID]] | ||
Revision as of 14:36, 4 July 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
Diagnosis
- CBC, Complete Metabolic Panel – Liver enzymes usually elevated 2-10 times normal
- Blood cultures
- CXR
Management
- Doxycycline
- Adults: 100 mg BID
- Children < 45 kg: 2.2 mg/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