Coxiella burnetii infection

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Última revisão: 19 Sep 2025

Última atualização: 15 Oct 2025

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.

Definição

A zoonotic disease caused by the gram-negative, obligate, intracellular bacterium Coxiella burnetii.[1][2][3] 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.[4] Commonly known as Q fever.

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

Full details

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

Full details

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

Full details

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

Full details

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)

Full details

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

Stephen Gluckman, MD

Professor of Medicine

Medical Director, Penn Global Medicine

Hospital of the University of Pennsylvania

Penn International Medicine and Immunization Clinic; Penn Center for Primary Care

Philadelphia

Disclosures

SG declares that he has no competing interests.

Acknowledgements

Professor Stephen Gluckman would like to gratefully acknowledge Dr Joshua Hartzell, 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. JH and NG declare that they have 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

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.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Anderson A, Bijlmer H, Fournier PE, et al. Diagnosis and management of Q fever - United States, 2013: recommendations from CDC and the Q fever working group. MMWR Recomm Rep. 2013 Mar 29;62(RR-03):1-23.Full text Abstract

National Association of State Public Health Veterinarians, National Assembly of State Animal Health Officials. Prevention and control of coxiella burnetii infection among humans and animals: guidance for a coordinated public health and animal health response, 2013. 2013 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- Legionella infection
- Tularaemia
- Viral hepatitis
More Differentials
Guidelines
- Clinical guidance for Q fever
- A guide to utilization of the microbiology laboratory for diagnosis of infectious diseases
More Guidelines
Patient information
Flu
More Patient information
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Coxiella burnetii infection

Resumo

Definição

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Treatment algorithm

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

suspected or confirmed persistent focalised infection, with no severe immunodeficiency

suspected or confirmed persistent focalised infection, with severe immunodeficiency

Contributors

Authors

Stephen Gluckman, MD

Disclosures

Acknowledgements

Disclosures

Peer reviewers

Jennifer McQuiston, DVM, MS, DACVPM

Disclosures

Dimitrios Chatzidimitriou, MD, PhD

Disclosures

Peer reviewer acknowledgements

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Patient information

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice