Coxiella burnetii infection is a notifiable condition in the US and some other countries.
People whose occupations put them at high risk of infection include abattoir workers, meat handlers, farmers, veterinarians, laboratory personnel, and military personnel.
Symptoms and complications correspond to either an acute infection or persistent focalised infections.
Infection during pregnancy may be associated with severe obstetric and fetal complications and endocarditis in the mother.
Acute infection can be treated with a short course of doxycycline, but persistent focalised infections require long-term therapy with doxycycline plus hydroxychloroquine. Surgical resection of infected vascular tissue or prosthetic material may also be required.
A zoonotic disease caused by the gram-negative, obligate, intracellular bacterium Coxiella burnetii. Many species of mammals, birds, and ticks are reservoirs of the bacterium, and the disease is spread globally through close contact with wild or domestic animals, especially their products of parturition, and also their urine, faeces, or milk. However, C burnetii small cell variant (pseudospores) can spread by air up to 10 kilometres from the source of infection so that exposure history is frequently lacking. Symptoms and complications are different between acute infection (i.e., a self-limiting febrile illness with varying degrees of pneumonia and hepatitis) and persistent focalised infections (e.g., endocarditis, vascular infection, osteoarticular infection, lymphadenitis). Infection during pregnancy has a specific clinical presentation (mostly asymptomatic), and may result in obstetric and fetal complications. Commonly known as Q fever.
History and exam
- cerebrospinal fluid cell count and differential
- cerebrospinal fluid protein
- cerebrospinal fluid glucose
- 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
- fluorescence in situ hybridisation (FISH)
Joshua Hartzell, MD, MS-HPEd, FACP, FIDSA
Division of Infectious Diseases
Uniformed Services University of the Health Sciences
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.
Dr Joshua Hartzell would like to gratefully acknowledge Dr Matthieu Million, Professor Didier Raoult, and Dr Nilmarie Guzman, previous contributors to this topic.
MM and DR are authors of several references cited in this topic. NG declares that she has no competing interests.
Jennifer McQuiston, DVM, MS, DACVPM
Rickettsial Zoonoses Branch
National Center for Zoonotic Vectorborne and Enteric Diseases
Centers for Disease Control and Prevention
JM declares that she has no competing interests.
Dimitrios Chatzidimitriou, MD, PhD
National Influenza Center
Second Department of Microbiology
Aristotle University of Thessaloniki Medical School
DC declares that he has no competing interests.
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