Coxiella burnetti Infection in Children

Abstract

The epidemiology, clinical manifestations, and management of Coxiella burnetti infection in children have not been summarized and updated since 2002. Aerosolization from the birth process of infected mammals accounts for almost all cases. Diagnosis requires a compatible clinical picture and serology that meets the criteria for acute or for persistent focal (chronic) infection. Acute disease is rarely diagnosed in children but it is not clear whether this is because infection is rare, infection is usually asymptomatic, or the diagnosis is usually missed. Fever is the main manifestation of acute disease; there are remarkably few case reports of pneumonia in children and almost none of hepatitis. There are no well-documented cases of breast milk transmission. Cases of persistent focal infection manifesting as endocarditis (N = 18) and osteomyelitis (N = 28) are summarized. The majority of cases of the latter progress to chronic recurrent multifocal osteomyelitis (CRMO). There are no published recommendations for management of acute or persistent focal infection in children. The possibility of C. burnetti infection should be considered for all children with culture-negative endocarditis or with CRMO. Exposure at any time to parturient mammals increases the risk of infection, but because the bacteria travels long distances on the wind, the absence of such a history should not preclude requesting serology. The selection and duration of antibiotics for persistent focal infection should be extrapolated from adult recommendations.