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Coxiella burnetii pneumonia
1Dept of Medicine, University of Alberta, Edmonton, Alberta, Canada. tom.marrie@ualberta.ca
Abstract:
This report reviews the pulmonary and extrapulmonary manifestation of infections due to Coxiella burnetii. Q fever, a zoonosis, is due to infection with C. burnetii. This spore-forming microorganism is a small gram-negative coccobacillus that is an obligate intracellular parasite. The most common animal reservoirs are goats, cattle, sheep, cats, and occasionally dogs. The organism reaches high concentrations in the placenta of infected animals. Aerosolisation occurs at the time of parturition and infection follows inhalation of this aerosol. There are three distinct clinical syndromes of the acute form of the illness: nonspecific febrile illness, pneumonia, and hepatitis. The chronic form of Q fever is almost always endocarditis, but occasionally it is manifest as hepatitis, osteomyelitis or endovascular infection. The pneumonic form of the illness can range from very mild-to-severe pneumonia requiring assisted ventilation. Multiple round opacities are a common finding on chest radiography. Treatment with doxycycline or a fluoroquinolone is preferred. Susceptibility to macrolides is variable. In conclusion, Coxiella burnetii pneumonia should be considered when there is a suitable exposure history and when outbreaks of a pneumonic illness are being investigated.
Insights
Coxiella burnetii causes Q fever, a zoonotic illness. This review covers its pulmonary and extrapulmonary symptoms, emphasizing pneumonia and endocarditis, and preferred treatments like doxycycline.
Area of Science:
- Infectious Diseases
- Pulmonology
- Microbiology
Background:
- Coxiella burnetii is an obligate intracellular parasite causing Q fever, a zoonosis primarily transmitted via aerosols from infected animal placentas.
- Common reservoirs include goats, cattle, sheep, cats, and dogs, with high organism concentrations in the placenta at parturition.
Purpose of the Study:
- To review the pulmonary and extrapulmonary manifestations of Coxiella burnetii infections.
- To highlight clinical syndromes, diagnostic findings, and treatment strategies for Q fever.
Main Methods:
- Review of literature on Coxiella burnetii infections, focusing on clinical presentations and epidemiological data.
- Analysis of diagnostic findings, including characteristic chest radiography findings in pneumonic cases.
- Summary of recommended antimicrobial therapies.
Main Results:
- Acute Q fever presents as nonspecific febrile illness, pneumonia, or hepatitis.
- Chronic Q fever commonly manifests as endocarditis, but can also involve hepatitis, osteomyelitis, or endovascular infections.
- Pneumonic Q fever ranges from mild to severe, often showing multiple round opacities on chest X-rays.
Conclusions:
- Coxiella burnetii pneumonia should be suspected with relevant exposure history, especially during outbreaks.
- Doxycycline or fluoroquinolones are the preferred treatments; macrolide susceptibility is variable.
- Understanding the diverse clinical spectrum of Q fever is crucial for timely diagnosis and management.