Difference between revisions of "Q fever"

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(Text replacement - "*CXR" to "*CXR")
 
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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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{{Lower respiratory zoonotic infections}}
 
{{Lower respiratory zoonotic infections}}
  
==Diagnosis==
+
==Evaluation==
* 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: 100mg BID
** Children < 45 kg: 2.2 mg/kg 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.
+
*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
+
*Most patients require admission for further workup
  
 
==See Also==
 
==See Also==
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==External Links==
 
==External Links==
  
==Sources==
+
==References==
 
<references/>
 
<references/>
 +
*http://www.cdc.gov/qfever/
 +
*http://www.ncbi.nlm.nih.gov/pubmed/16168313
  
 
[[Category:ID]]
 
[[Category:ID]]
* http://www.cdc.gov/qfever/
 
* Rosen’s Emergency Medicine 8th Edition
 
* www.uptodate.com
 
* http://www.ncbi.nlm.nih.gov/pubmed/16168313
 

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
  • 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

See Also

External Links

References