Emergency Preparedness

Kern Medical Bioterrorism Response Guide Section 2-A-4 – Q Fever ( Coxiella burnetii )

Complications may inc lude acute hepatitis in the absence of pulmonary symptoms, culture-negative endocarditis, aseptic meningitis, encephalitis, and osteomyelitis. Differential Diagnosis Other organisms to consider include Mycoplasma pneumoniae , Legionella pneumophila , Chlamydia psittaci , and Chlamydia pneumoniae . More progressive forms of pneumonia may resemble bacterial pneumonia, tularemia, or plague. Diagnosis Radiological Chest x-ray abnormalities may include pleural effusions, consolidation, atelectesis, hilar adenopathy, non-segmental and segmental pleural-based opacities, and multiple rounded opacities. Laboratory Diagnosis Leukocytosis is present in about one-third of infected persons. Routine bacterial cultures of the blood and sputum are generally negative. The hepatic transaminase levels may be elevated 2 – 3 times normal however the bilirubin is generally normal. The compliment fixation (CF) test is diagnostic if there is a fourfold rise in titer between the acute and convalescent serum samples. Treatment Although most cases of Q fever resolve without antibiotic treatment, all cases of infection should be treated for at least 5 – 7 days to reduce the risk of complications such as endocarditis. The antibiotics of choice include: ? Tetracycline 500 mg q 6 hours for 5 – 7 days ? Doxycycline 100 mg q 12 hours for 5 – 7days ? A quinolone such as ciprofloxacin may be given in place of tetracycline or doxycycline if the former antibiotics are not tolerated. Prophylaxis If prophylaxis is recommended, antibiotic therapy with tetracycline, doxycycline or a quinolone should be started 8 – 12 days following initial exposure. Isolation Standard Precautions are recommended.

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