1. Coxiella burnetii
Domina Petric, MD

2. Coxiella burnetii Causes Q-fever.
Q-fever is a zoonose: transmitted from domestic animals (sheeps) to humans (by aerosol).
Q-fever is an acute disease: high body temperature, abrupt onset, severe headaches, pain in muscles and general malaise.

3. Coxiella burnetii
Family Rickettsiaceae: gender Coxiella burnetii. It is an obligate intracellular parasite. Gram negative coccobacill, pleomorphic. Highly resistant on physical and chemical influences, on antibiotics, heat, sun rays...
Wikipedia.org

4. From 4 days only to 40 days maximum, usually two to three weeks.
Incubation
From 4 days only to 40 days maximum, usually two to three weeks.

5. Onset of disease
Abruptly! Temperature is usually very high, even more than 40 degrees of celsius with or without shivering. General malaise and general algic syndrom, myalgias and very intensive headache. Intensive headache can be the leading symptom, sometimes accompanied with photophobia, meningism and somnolence. 25% of the patients have diarrhea and/or vomit. After the onset of the disease there is development of the disease in different ways: it can be pneumonia, short febrile disease, hepatitis, endocarditis or other forms of Q-fever.

6. Q-fever pneumonia
In 50% of the patients atypical pneumonia develops. After 5 to 7 days from the first symptoms, dry cough develops. Sometimes there is no cough at all, but the cough is almoust never productive. There can be pleural pain and chest stabbing. There can be also hepatosplenomegaly and meningism with normal CSF. Rash can also occure: mild erithema or short lasting maculopapular rash.

7. no findings at all (sometimes)
Physical findings
crepitations
vesicular breathing
no findings at all (sometimes)

8. Chest X ray interstitial infiltrates intensive density infiltrates
sharp demarcation of the infiltrates
multiple infiltrates
located basaly or in the periphery of lung parenchima
pleural effusions or hilar adenopathy rarely

9. Radiopaedia.org

10. Q fever tip!
Relatively large lung infiltrates and discrete or no physical findings on auscultation.

11. Laboratory testing
Erythrocytes sedimentation rate is normal at the beginning of the disease and later can be elevated. Leukocytes are usually normal, but there can be an elevation and left shift. CRP is usually low.

12. Q-fever hepatitis
There can be severe granulomatous inflammation of the liver.
Changes in the liver are reversible.
Prognosis is good.

13. Q-fever endocarditis Rare, but severe form of Q-fever.
Occurs in chronic form of Q-fever and affects mostly aortic valve.
Mortality is very high.

14. Treatment
Doxycycline 100 mg two times per os a day during 10 to 14 days. OR azithromycin!

15. Literature:
Begovac J. Božinović D. Lisić M. Baršić B. Schönwald S. Infectology, Profil. Wikipedia.org Radiopaedia.org