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Key Features

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  • Caused by inhalation of Coxiella burnetii

  • Exposure to farm animals (sheep, goats, cattle) and pets

  • Unpasteurized milk from infected animals may also transmit disease

  • Flu-like illness (fever, severe headache, myalgia)

  • Cough; atypical pneumonia

  • Hepatomegaly and hepatitis

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Clinical Findings

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  • Abrupt onset of self-limited flu-like syndrome occurring 10–25 days after exposure

  • Abdominal pain, vomiting, chest pain, and dry cough are prominent in children

  • Hepatosplenomegaly is common

  • Illness lasts 1–4 weeks and frequently is associated with weight loss

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Diagnosis

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  • Leukopenia with left shift is characteristic

  • Aminotransferase and γ-glutamyl transferase levels are elevated

  • Diagnosis is made by finding an antibody response (fourfold rise or single high titer in ELISA; IFA, or CF antibody assay) to the phase II organism

  • Chronic infection is indicated by antibody against the phase I organism

  • Pneumonitis occurs in 50% of patients

  • Multiple segmental infiltrates are common, but the radiographic appearance is not pathognomonic

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Treatment

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  • Self-limited, illness typically lasts 1–2 weeks without therapy

  • Doxycycline shortens course of uncomplicated illness

  • Therapy is continued for several days after the patient becomes afebrile (usually 10–14 days)

  • Quinolones are also effective

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