Coxiella burnetii - Revision history

Aidan: /* CNS infections */

2022-07-13T19:05:18Z

CNS infections

← Older revision		Revision as of 19:05, 13 July 2022
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	*More common in Europe and Americas		*More common in Europe and Americas

	===CNS ~~infections~~===		===CNS Infections===

	*Can cause Miller-Fischer variant of Guillain-Barré syndrome		*Can cause Miller-Fischer variant of Guillain-Barré syndrome

Aidan: /* Management */

2020-09-22T14:57:15Z

Management

← Older revision		Revision as of 14:57, 22 September 2020
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	*Acute Q fever		*Acute Q fever
	**Consider screening for bicuspid valve with TTE if high risk, or baseline TTE		**Consider screening for bicuspid valve with TTE if high risk, or baseline TTE
	**[[~~Doxycyxline~~]] 100mg po bid x 10-14 days		**[[Doxycycline]] 100mg po bid x 10-14 days
	**Second-line is [[fluoroquinolones]] or [[macrolides]]		**Second-line is [[fluoroquinolones]] or [[macrolides]]
	**Consider monitoring titres for some period afterwards		**Consider monitoring titres for some period afterwards

Aidan: /* Considerations in Pregnancy */

2020-09-22T14:56:59Z

Considerations in Pregnancy

← Older revision		Revision as of 14:56, 22 September 2020
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	**Measure titres every 3-6 months during treatment, then every 3 months for 2 years after completing treatment		**Measure titres every 3-6 months during treatment, then every 3 months for 2 years after completing treatment

	==~~Considerations in~~ Pregnancy==		===Pregnancy===

	*''Coxiella'' loves the placenta		*''Coxiella'' loves the placenta

Aidan: /* Considerations in Pregnancy */

2020-08-13T00:10:17Z

Considerations in Pregnancy

← Older revision		Revision as of 00:10, 13 August 2020
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	*Acute Q fever		*Acute Q fever
	**Consider screening for bicuspid valve with TTE if high risk, or baseline TTE		**Consider screening for bicuspid valve with TTE if high risk, or baseline TTE
	**Doxycyxline 100mg po bid x 10-14 days		**[[Doxycyxline]] 100mg po bid x 10-14 days
	**Second-line is fluoroquinolones or macrolides		**Second-line is [[fluoroquinolones]] or [[macrolides]]
	**Consider monitoring titres for some period afterwards		**Consider monitoring titres for some period afterwards
	**In patients with prosthetic heart valves, consider prolonged treatment as per chronic Q fever (like 1 year)		**In patients with prosthetic heart valves, consider prolonged treatment as per chronic Q fever (like 1 year)
	*Chronic Q fever		*Chronic Q fever
	**Definitely screen for endocarditis		**Definitely screen for [[endocarditis]]
	**Doxycycline + hydroxychloroquine 200mg/d continued until phase I IgG titres have decreased to ≤1:800		**[[Doxycycline]] + [[hydroxychloroquine]] 200mg/d continued until phase I IgG titres have decreased to ≤1:800
	***Hydroxychloroquine potentiates doxycycline in the phagolysosomes (makes the ~~doxy~~ bactericidal)		***[[Hydroxychloroquine]] potentiates [[doxycycline]] in the phagolysosomes (makes the doxycycline bactericidal)
	***Monitor for ophthalmologic complications, and both have photosensitivity		***Monitor for ophthalmologic complications, and both have photosensitivity
	***Can adjust dose of hydroxychloroquine to target serum level 0.8 to 1.2 mcg/mL		***Can adjust dose of [[hydroxychloroquine]] to target serum level 0.8 to 1.2 mcg/mL
	**Duration 1.5 years for native valve endocarditis, 2 years for prosthetic valve endocarditis		**Duration 1.5 years for native valve [[endocarditis]], 2 years for [[prosthetic valve endocarditis]]
	**Measure titres every 3-6 months during treatment, then every 3 months for 2 years after completing treatment		**Measure titres every 3-6 months during treatment, then every 3 months for 2 years after completing treatment

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	*It can be a cause of flu-like illness in pregnant women with a potential exposure history		*It can be a cause of flu-like illness in pregnant women with a potential exposure history
	**This can be associated with first-trimester pregnancy loss		**This can be associated with first-trimester pregnancy loss
	*Doxycycline and fluoroquinolones are contraindicated		*[[Doxycycline]] and [[fluoroquinolones]] are contraindicated
	*~~Septra~~ 1600/320 daily, make sure they're on folic acid supplementation		*[[TMP-SMX]] 1600/320 daily, make sure they're on folic acid supplementation
	**Continue it for the duration of pregnancy		**Continue it for the duration of pregnancy
	**Theoretic risk of hyperbilirubinemia in third trimester, so may consider holding it towards the end unless there's documented chronic infection		**Theoretic risk of [[hyperbilirubinemia]] in third trimester, so may consider holding it towards the end unless there's documented chronic infection
	*High risk of developing chronic infection, so titres should be monitored for at least 2 years		*High risk of developing chronic infection, so titres should be monitored for at least 2 years
	**If persistent IgG > 800, consider TEE		**If persistent IgG > 800, consider TEE

Aidan: /* Considerations in Pregnancy */

2020-08-13T00:07:55Z

Considerations in Pregnancy

Show changes

Aidan: /* Epidemiology */

2020-08-05T13:55:21Z

Epidemiology

← Older revision		Revision as of 13:55, 5 August 2020
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	** Can also be found in stool, urine, and milk		** Can also be found in stool, urine, and milk
	** Unpasteurized milk		** Unpasteurized milk
	* Inhaled by humans with an incubation period of 20 days (1 to 39 days)		* Inhaled by humans with an incubation period of [[Usual incubation period::20 days]] ([[Incubation period range::1 to 39 days]])
	** Dose-dependent incubation period		** Dose-dependent incubation period
	** Chronic Q fever can be up to 6 months		** Chronic Q fever can be up to 6 months

Aidan: Text replacement - "Clinical Presentation" to "Clinical Manifestations"

2020-07-22T00:53:06Z

Text replacement - "Clinical Presentation" to "Clinical Manifestations"

← Older revision		Revision as of 00:53, 22 July 2020
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	* QPH1 is a more virulent strain		* QPH1 is a more virulent strain

	== Clinical ~~Presentation~~ ==		== Clinical Manifestations ==
	* Can present as asymptomatic, self-limited febrile illness lasting 2 to 14 days (most common), pneumonia, or hepatitis		* Can present as asymptomatic, self-limited febrile illness lasting 2 to 14 days (most common), pneumonia, or hepatitis
	** Asymptomatic more common in pregnant women and children		** Asymptomatic more common in pregnant women and children

Aidan at 15:27, 19 January 2020

2020-01-19T15:27:15Z

← Older revision		Revision as of 15:27, 19 January 2020
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	== ~~History~~ ==		== Background ==
			=== History ===

	* Originally described in Australia in 1935 among workers at a meatworks		* Originally described in Australia in 1935 among workers at a meatworks
	* Q fever, for query fever, because the doctor suspected a new infection		* Q fever, for query fever, because the doctor suspected a new infection

	== Microbiology ==		=== Microbiology ===

	* Highly pleomorphic, intracellular, spore-forming, Gram-negative coccobacillus that causes Q fever		* Highly pleomorphic, intracellular, spore-forming, Gram-negative coccobacillus that causes Q fever
	** Enters cell passively		** Enters cell passively
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	* Related to rickettsiae		* Related to rickettsiae

	== Epidemiology ==		=== Epidemiology ===

	* Zoonotic disease, most commonly of cattle, sheep, and goats		* Zoonotic disease, most commonly of cattle, sheep, and goats
	** Also infected peripartum cats		** Also infected peripartum cats
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	** Hepatitis more in Europe, pneumonia more in US		** Hepatitis more in Europe, pneumonia more in US

	== Risk Factors ==		=== Risk Factors ===

	* Working with or near animals, especially peripartum		* Working with or near animals, especially peripartum
	* Lab exposure		* Lab exposure
	* Unpasteurized milk		* Unpasteurized milk

	== Pathophysiology ==		=== Pathophysiology ===

	* Bacteria enter lungs, where they proliferate in the macrophages and invade the bloodstream		* Bacteria enter lungs, where they proliferate in the macrophages and invade the bloodstream
	** Lives in the phagolysosome		** Lives in the phagolysosome
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	* QPH1 is a more virulent strain		* QPH1 is a more virulent strain

	== ~~Syndromes~~ ==		== Clinical Presentation ==

	* Can present as asymptomatic, self-limited febrile illness lasting 2 to 14 days (most common), pneumonia, or hepatitis		* Can present as asymptomatic, self-limited febrile illness lasting 2 to 14 days (most common), pneumonia, or hepatitis
	** Asymptomatic more common in pregnant women and children		** Asymptomatic more common in pregnant women and children
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	=== Acute Q fever ===		=== Acute Q fever ===

	* Fever is uniform finding in all syndromes		* Fever is uniform finding in all syndromes
	* Chills, headache (severe), fatigue, and myalgias that lasts 2-21 days (14)		* Chills, headache (severe), fatigue, and myalgias that lasts 2-21 days (14)
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	=== Pneumonia ===		=== Pneumonia ===

	* Can present as an atypical pneumonia, a rapidly-progressing pneumonia, and an incidental pneumonia in a febrile patient (most common)		* Can present as an atypical pneumonia, a rapidly-progressing pneumonia, and an incidental pneumonia in a febrile patient (most common)
	* A community-acquired pneumonia that doesn't respond to first-line antibiotics (like Legionella and pneumonic tularemia)		* A community-acquired pneumonia that doesn't respond to first-line antibiotics (like Legionella and pneumonic tularemia)
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	=== Hepatitis ===		=== Hepatitis ===

	* Three forms:		* Three forms:
	** An infectious hepatitis–like picture		** An infectious hepatitis–like picture
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	=== CNS infections ===		=== CNS infections ===

	* Can cause Miller-Fischer variant of Guillain-Barré syndrome		* Can cause Miller-Fischer variant of Guillain-Barré syndrome

	=== Endocarditis ===		=== Endocarditis ===

	* Subacute or chronic febrile illess		* Subacute or chronic febrile illess
	* Clubbing and hepatosplenomegaly are common		* Clubbing and hepatosplenomegaly are common
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	== Diagnosis ==		== Diagnosis ==

	* Not readily culturable (nor should you try), though you can see it with Giemsa stain		* Not readily culturable (nor should you try), though you can see it with Giemsa stain
	* PCR is possible though not common		* PCR is possible though not common
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	=== Serology ===		=== Serology ===

	* Immunofluorescence assay is standard; no need for EIA		* Immunofluorescence assay is standard; no need for EIA
	* Two phases of IgG antibodies (phase I and II)		* Two phases of IgG antibodies (phase I and II)
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	== Management ==		== Management ==

	* Acute Q fever		* Acute Q fever
	** Consider screening for bicuspid valve with TTE if high risk, or baseline TTE		** Consider screening for bicuspid valve with TTE if high risk, or baseline TTE
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	== Considerations in Pregnancy ==		== Considerations in Pregnancy ==

	* ''Coxiella'' loves the placenta		* ''Coxiella'' loves the placenta
	* It can be a cause of flu-like illness in pregnanct women with a potential exposure history		* It can be a cause of flu-like illness in pregnanct women with a potential exposure history
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	== Prevention ==		== Prevention ==

	* Vaccinate high-risk workers		* Vaccinate high-risk workers

	{{DISPLAYTITLE:''Coxiella ~~burnetti~~''}}		{{DISPLAYTITLE:''Coxiella burnetii''}}
	[[Category:Rickettsioses]]		[[Category:Rickettsioses]]

Aidan: Aidan moved page Coxiella burnetti to Coxiella burnetii without leaving a redirect

2020-01-19T15:25:10Z

Aidan moved page Coxiella burnetti to Coxiella burnetii without leaving a redirect

← Older revision	Revision as of 15:25, 19 January 2020
(No difference)

Aidan at 10:45, 16 August 2019

2019-08-16T10:45:44Z

← Older revision		Revision as of 10:45, 16 August 2019
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	= History =		== History ==

	* Originally described in Australia in 1935 among workers at a meatworks		* Originally described in Australia in 1935 among workers at a meatworks
	* Q fever, for query fever, because the doctor suspected a new infection		* Q fever, for query fever, because the doctor suspected a new infection

	= Microbiology =		== Microbiology ==

	* Highly pleomorphic, intracellular, spore-forming, Gram-negative coccobacillus that causes Q fever		* Highly pleomorphic, intracellular, spore-forming, Gram-negative coccobacillus that causes Q fever
Line 12:		Line 12:
	* Related to rickettsiae		* Related to rickettsiae

	= Epidemiology =		== Epidemiology ==

	* Zoonotic disease, most commonly of cattle, sheep, and goats		* Zoonotic disease, most commonly of cattle, sheep, and goats
Line 29:		Line 29:
	** Hepatitis more in Europe, pneumonia more in US		** Hepatitis more in Europe, pneumonia more in US

	= Risk Factors =		== Risk Factors ==

	* Working with or near animals, especially peripartum		* Working with or near animals, especially peripartum
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	* Unpasteurized milk		* Unpasteurized milk

	= Pathophysiology =		== Pathophysiology ==

	* Bacteria enter lungs, where they proliferate in the macrophages and invade the bloodstream		* Bacteria enter lungs, where they proliferate in the macrophages and invade the bloodstream
Line 44:		Line 44:
	* QPH1 is a more virulent strain		* QPH1 is a more virulent strain

	= Syndromes =		== Syndromes ==

	* Can present as asymptomatic, self-limited febrile illness lasting 2 to 14 days (most common), pneumonia, or hepatitis		* Can present as asymptomatic, self-limited febrile illness lasting 2 to 14 days (most common), pneumonia, or hepatitis
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	* Post-Q fever fatigue syndrome		* Post-Q fever fatigue syndrome

	== Acute Q fever ==		=== Acute Q fever ===

	* Fever is uniform finding in all syndromes		* Fever is uniform finding in all syndromes
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	* Palpable purpura can be seen in chronic Q fever (that is, endocarditis)		* Palpable purpura can be seen in chronic Q fever (that is, endocarditis)

	== Pneumonia ==		=== Pneumonia ===

	* Can present as an atypical pneumonia, a rapidly-progressing pneumonia, and an incidental pneumonia in a febrile patient (most common)		* Can present as an atypical pneumonia, a rapidly-progressing pneumonia, and an incidental pneumonia in a febrile patient (most common)
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	* More common in Americas than Europe		* More common in Americas than Europe

	== Hepatitis ==		=== Hepatitis ===

	* Three forms:		* Three forms:
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	* More common in Europe and Americas		* More common in Europe and Americas

	== CNS infections ==		=== CNS infections ===

	* Can cause Miller-Fischer variant of Guillain-Barré syndrome		* Can cause Miller-Fischer variant of Guillain-Barré syndrome

	== Endocarditis ==		=== Endocarditis ===

	* Subacute or chronic febrile illess		* Subacute or chronic febrile illess
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	* Higher titres are more convincing ≥1:6400		* Higher titres are more convincing ≥1:6400

	= Diagnosis =		== Diagnosis ==

	* Not readily culturable (nor should you try), though you can see it with Giemsa stain		* Not readily culturable (nor should you try), though you can see it with Giemsa stain
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	* Main method of detection is serology		* Main method of detection is serology

	== Serology ==		=== Serology ===

	* Immunofluorescence assay is standard; no need for EIA		* Immunofluorescence assay is standard; no need for EIA
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	* IgM antibodies are usually undetectable by 4 months, though IgG may persist for more than a decade		* IgM antibodies are usually undetectable by 4 months, though IgG may persist for more than a decade

	= Management =		== Management ==

	* Acute Q fever		* Acute Q fever
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	** Measure titres every 3-6 months during treatment, then every 3 months for 2 years after completing treatment		** Measure titres every 3-6 months during treatment, then every 3 months for 2 years after completing treatment

	= Considerations in Pregnancy =		== Considerations in Pregnancy ==

	* ''Coxiella'' loves the placenta		* ''Coxiella'' loves the placenta
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	** If persistent IgG > 800, consider TEE		** If persistent IgG > 800, consider TEE

	= Prevention =		== Prevention ==

	* Vaccinate high-risk workers		* Vaccinate high-risk workers

	{{DISPLAYTITLE:''Coxiella burnetti''}}		{{DISPLAYTITLE:''Coxiella burnetti''}}
	[[Category:~~Gram-negative bacteria~~]]		[[Category:Rickettsioses]]