Chapter

<i>Coxiella burnetii</i> infections (Q fever)

T.J. Marrie

in Oxford Textbook of Medicine

Fifth edition

Published on behalf of Oxford University Press

ISBN: 9780199204854
Published online May 2012 | e-ISBN: 9780199570973 | DOI: http://dx.doi.org/10.1093/med/9780199204854.003.070641_update_002

Series: Oxford Textbooks

Coxiella burnetii infections (Q fever)

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Q fever is a zoonosis caused by Coxiella burnetii, an intracellular Gram-negative spore-forming bacterium, the common animal reservoirs of which are cattle, sheep, and goats, although in a large outbreak in the Netherlands it appears that rats, Rattus norvegicus and R. rattus, may have played a role in the spread of the condition. C. burnetti is trophic for the endometrium and mammary glands of female animals, and during pregnancy the organism reaches very high concentrations in the placenta such that at the time of parturition organisms are aerosolized and contamination of the environment occurs. Inhalation of even one microorganism can result in infection.

Clinical features—there are two main forms of the disease: (1) acute—can present as inapparent infection, self-limited febrile illness, pneumonia, and hepatitis, or less commonly with a variety of organ-specific manifestations such as encephalitis, pericarditis, and pancreatitis; Q fever in pregnancy is associated with a high rate of abortion or neonatal death. (2) Chronic—most often ‘culture-negative’ endocarditis or infection of aortic aneurysms, but occasionally osteomyelitis.

Diagnosis, treatment, and prevention—diagnosis is confirmed by serological testing: in acute disease antibodies to phase II antigen are higher than those to phase I, whereas the reverse is true in chronic disease. Acute Q fever is treated with doxycyline or a quinolone; chronic disease with long-term doxycycline and hydroxychloroquine; and Q fever in pregnancy with co-trimoxazole for the duration of the pregnancy and—for those with a chronic Q fever serological profile—1 year of doxycycline and hydroxyochloroquine after delivery. Vaccination should be offered to those whose occupation places them at high risk for C. burnetii infection.

Chapter.  3235 words.  Illustrated.

Subjects: Medical Microbiology and Virology ; Infectious Diseases

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