#idboardreview 30 goat farmer helped w/ goats birth 20d ago now presents w/ fever, rigors, severe retrobulbar headache, dyspnea, hepatitis. Dx? #medEd #idmedEd #IDtwitter
#coxiella burnetti (Q fever) manifest as a self-limited febrile illness, pneumonia, endocarditis, or hepatitis. There are many other less common manifestations, such as meningitis, encephalitis, and osteomyelitis. Infections are divided into acute and chronic forms.
#Qfever zoonosis usually acquired by inhalation or, much less commonly, by ingesting unpasteurized milk
Cattle, sheep, goats most common reservoirs
Infected parturient cats are important in spread in some areas
-extensive wildlife reservoir
-Windborne spread occur over 10 km
Pleomorphic gram-neg (structurally doesnt stain w Gram stain) coccobacillus
#Coxiella burnetii: only species in genus
Intracellular pathogen
Spore former
-acute infection leads to Ab against phase II Ag
chronic infections, such as endocarditis: IgG Ab against phase I Ag
Acute Qfever: 4 fold⬆️in titer b/w acute & convalescent samples
-Chronic #Qfever Dx clinical + IgG phase I titer equal to or >phase II & at least 1 : 1600
-Isolation of C. burnetii using shell vial technique in BSL 3 lab
-PCR on heart valve or joint fluid
FISH can id in tissue
Acute #Qfever: 10 days of doxycycline, a fluoroquinolone or a macrolide
Chronic Q fever: Doxycycline plus hydroxychloroquine until phase I IgG antibody decline to 1:800 or less

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More from @IUIDfellowship

14 May
#idboardreview 25 MSM PLWH on ART VL<20 presents w/ rectal bleeding, dyschezia x 1mo. Anoscopy anal ulcer. Biopsy suspicious for IBD. Sigmoidoscopy erythematous mucosa w/white exudates & heaped folds. Starry abscess. Dx? #medEd @idmedEd #IDtwitter Image
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#brucellosis ddx chronic meningitis
Pic ref phil.cdc.gov/Details.aspx?p…
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#idboardreview 18 M altered mental status, difficulty walking, urinary retention, sx progressive x4d. He had parotitis/orchitis 2wks ago. CSF150 wbc 100%mono ⬆️protein, gram stain/culture neg. mri leptomeningeal enhancement. Dx? #medEd #idmedEd #IDtwitter
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9 May
#idboardreview 30 M from western 🇺🇸 visited Middle East where symptoms of recurrent fevers >102F, headaches, myalgia, chills started
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Rick borne relapsing fever #TBRF #Borrelia persica inspired by jcm.asm.org/content/58/6/e… @ASMicrobiology pic ref P&P Mandell
median incubation period of 7d (range 2-18d): fever x 3d (range 2-7d), alternating w/ afebrile periods lasting about 7d range 4-14d)
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whereas louse-borne illness is usually has only 1 relapse
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#idboardreview 30 M Paraguay 🇵🇾 living w/ HIV CD4 50 VL 100k presents w/ seizure, no travel/animal contact. Oriented to self, dysarthria, csf (wbc 15 100% lymph, protein80, gluc35). Dx? #medEd #idmedEd #idtwitter
Meningoencephalitis and chagoma, caused by #Trypanosoma cruzi
#Chagas or American #trypanosomiasis parasitic protozoan #Animal Trypanosoma cruzi transmitted by hematophagous “kissing bugs” Reduviidae aka
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barbeiro (Brazil),
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19 Mar
#idboardreview 40 M injected heroin boiled with tap water, previously used needle: next day developed periorbital swelling, eyelid erythema, pain and blurred vision of one eye. Dx? #medEd #idmedEd #IDtwitter
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