Coxiella burnetii infection

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.[1]Marrie TJ, Raoult D. Coxiella burnetii. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and practice of infectious diseases. 6th ed. Philadelphia, PA: Churchill Livingstone; 2005.[2]Hartzell JD, Wood-Morris RN, Martinez LJ, et al. Q fever: epidemiology, diagnosis, and treatment. Mayo Clin Proc. 2008 May;83(5):574-9. https://www.mayoclinicproceedings.org/article/S0025-6196(11)60733-7/fulltext http://www.ncbi.nlm.nih.gov/pubmed/18452690?tool=bestpractice.com [3]Eldin C, Mélenotte C, Mediannikov O, et al. From Q fever to Coxiella burnetii infection: a paradigm change. Clin Microbiol Rev. 2017 Jan;30(1):115-90. https://cmr.asm.org/content/30/1/115.long http://www.ncbi.nlm.nih.gov/pubmed/27856520?tool=bestpractice.com 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]Million M, Roblot F, Carles D, et al. Reevaluation of the risk of fetal death and malformation after Q fever. Clin Infect Dis. 2014 Jul 15;59(2):256-60. https://academic.oup.com/cid/article/59/2/256/2895572 http://www.ncbi.nlm.nih.gov/pubmed/24748522?tool=bestpractice.com Commonly known as Q fever. 

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