Coxiella burnetii infection

Last reviewed: 5 Sep 2022
Last updated: 10 Dec 2020

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • abrupt onset of high fever
  • flu-like illness
  • severe headache
  • cough
  • inspiratory crackles, rhonchi, or wheezing
  • hepatomegaly
More key diagnostic factors

Other diagnostic factors

  • exanthemas
  • pleuritic chest pain
  • seizures
  • coma
  • chronic fatigue
  • signs of endocarditis or vascular infection (persistent focalised infection)
  • other signs of persistent focalised infection
  • other signs of acute infection
Other diagnostic factors

Risk factors

  • exposure to infected animals
  • occupational exposure
  • travel or residency in endemic areas
  • male sex
  • age 30 to 70 years
  • immunosuppression
  • pre-existing cardiac disease
  • pre-existing vasculopathy
  • pregnancy
More risk factors

Diagnostic investigations

1st investigations to order

  • indirect immunofluorescence assay (IFA)
  • polymerase chain reaction (PCR)
  • FBC
  • CRP
  • LFTs
  • activated partial thromboplastin time (aPTT)
  • IgG anticardiolipin (aCL) antibodies
More 1st investigations to order

Investigations to consider

  • cerebrospinal fluid cell count and differential
  • cerebrospinal fluid protein
  • cerebrospinal fluid glucose
  • CXR
  • transthoracic echocardiography (TTE)
  • transoesophageal echocardiography (TOE)
  • liver ultrasound
  • abdominal CT scan or ultrasound
  • chest CT
  • brain CT
  • 18F-fluorodeoxyglucose (FDG) PET/CT imaging
  • lymph node biopsy
  • immunohistochemistry
  • fluorescence in situ hybridisation (FISH)
More investigations to consider

Treatment algorithm

ACUTE

acute infection, non-pregnant, no severe immunodeficiency: at low risk of persistent focalised infection

acute infection, non-pregnant, no severe immunodeficiency: at high risk of persistent focalised infection

acute infection, non-pregnant, with severe immunodeficiency

acute infection, pregnant

ONGOING

suspected or confirmed persistent focalised infection, with no severe immunodeficiency

suspected or confirmed persistent focalised infection, with severe immunodeficiency

Contributors

Authors

Joshua Hartzell, MD, MS-HPEd, FACP, FIDSA

Division of Infectious Diseases

Uniformed Services University of the Health Sciences

Bethesda

MD

Disclosures

JH declares he has no competing interests. The opinions or assertions contained herein are the private ones of the reviewer and are not to be construed as official or reflecting the views of the Department of Defense, the Uniformed Services University of the Health Sciences, or any other agency of the US Government.

Acknowledgements

Dr Joshua Hartzell would like to gratefully acknowledge Dr Matthieu Million, Professor Didier Raoult, and Dr Nilmarie Guzman, previous contributors to this topic.

Disclosures

MM and DR are authors of several references cited in this topic. NG declares that she has no competing interests.

Peer reviewers

Jennifer McQuiston, DVM, MS, DACVPM

Epidemiology Team

Rickettsial Zoonoses Branch

National Center for Zoonotic Vectorborne and Enteric Diseases

Centers for Disease Control and Prevention

Atlanta

GA

Disclosures

JM declares that she has no competing interests.

Dimitrios Chatzidimitriou, MD, PhD

Clinical Microbiologist

National Influenza Center

Second Department of Microbiology

Aristotle University of Thessaloniki Medical School

Thessaloniki

Greece

Disclosures

DC declares that he has no competing interests.

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