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Saturday, December 8, 2012

Q Fever-An interesting case managed at SevenHills Hospital

Q fever was first described in Queensland Australia in 1935.This is an infection which is transmitted when a person comes in contact with parturient fluids of an infected pregnant animal (goat, sheep, cattle, etc), or other fluids like urine, faeces or milk. It has been reported worldwide and is recognized as an important cause of fever with multi-organ failure. In India, the infection has been documented in animals across the country.
One of our patient, a painter by profession, developed high grade fever, dry cough, running nose with severe body ache after coming back from a leave of 6 months from his hometown in UP, India. He was treated by a general practioner with some medicines to which there was no response. His condition gradually worsened over a period of 1 week. He started developing difficulty in breathing along with headache, weakness and giddiness. He presented to Dr. Amit Panjwani, SevenHills Hospital in a critical condition with respiratory failure, low blood pressure and rashes over his face and chest. On evaluation he was found to have pneumonia, enlarged liver and spleen, low blood oxygen levels with low platelets. His liver functions were mildly deranged and tests for malaria and leptospirosis were negative. He was treated in the ICCU with broad spectrum antibiotics, intravenous fluids, and non-invasive ventilatory support. Patient showed some improvement however, his respiratory failure and low platelet counts continued to persist. At this juncture, he was re-evaluated in detail with a CT scan of the Chest and the Pulmonary Function Tests. After going through the reports and the patient’s occupation history, a possibility of an unusual bacterial infection was entertained. The sample tested positive for Coxiella burnetti, the organism responsible for a condition called Q fever. The patient was treated with the appropriate antibiotic, Doxycycline. He showed a dramatic response to this drug. The patient’s general condition improved in a couple of days with the platelet counts coming back to normal levels and resolution of the respiratory failure completely. Patient was discharged from the hospital in a completely normal condition.
Q fever can present as flu- like illness in majority of the cases and it is self limiting illness which resolves without any treatment. In 30-50 % of the cases it can present with ‘‘atypical pneumonia’’ which may be associated with multi-organ involvement. In approximately 5 % of the cases it can present as a chronic infection which can affect the heart, liver and bones.
Pregnant women are at an increased risk of suffering from this infection which can result in various complications including abortions, in utero-deaths, premature deliveries and low birth weight babies. This infection can result in death in 2-3% of patients who are not treated adequately with appropriate antibiotics.
Our patient had an acute Q fever with atypical pneumonia and multi-organ involvement. This is the first reported case in our country in this presentation. With the animal –man contact being very common, it is felt that such an infection should not be rare in our country. It is only that the doctors should be aware of this possibility when treating cases with fever, pneumonia and low platelet counts.

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