Abstract
Q fever is a zoonosis caused by Coxiella burnetii with worldwide distribution at the increasing expression in Europe and endemic in Portugal. It is transmitted by inhalation of aerosols containing spores, main reservoir being cattle, goats and sheep as by ingesting cottage cheese or unpasteurized milk. The majority of patients are asymptomatic; however, they may present with fever, atypical pneumonia, acute hepatitis, cutaneous manifestations and rarely with cardiac or neurological involvement. Although most cases are self-limited, focal persistent or chronic Q fever can manifest years after the onset, wherefore follow-up is essential. The clinical heterogeneity may be so variable that the disease is often diagnosed only if it has been systematically considered. It should be especially taken into account in the presence of risk factors as valvular or joint prostheses, immunocompromised patients, pregnant women and epidemiological setting. The authors present a rare case of Coxiella burnetii pneumonia with cutaneous and hepatic manifestations without any risk factor. This case aims to emphasize the importance of Q fever in the differential diagnosis of fever or atypical pneumonia, even in the absence of known risk factors. The diagnosis is often challenging for clinicians and it is necessary to maintain a high index of suspicion. In Europe and specifically in Portugal is mandatory to report the cases to establish the real impact of this disease.
Highlights
In Portugal undiagnosed and underreported [1] it's a mandatory declaration diseases and according to the National Information System for Epidemiological Surveillance (SINAVE) with 87 reported cases between 2013 and 2016 [2]
This case aims to emphasize the importance of Q fever in the differential diagnosis of fever or atypical pneumonia, even in the absence of known risk factors
Treatment for acute Q fever is not routinely recommended for asymptomatic persons or for those whose symptoms have resolved, it might be considered in those at high risk for developing chronic Q fever [7]
Summary
In Portugal undiagnosed and underreported [1] it's a mandatory declaration diseases and according to the National Information System for Epidemiological Surveillance (SINAVE) with 87 reported cases between 2013 and 2016 [2]. Focal persistent or chronic Q fever occurs less than 5% and can manifest months or years after the initial infection, mainly with localized clinical signs as endocarditis, chronic hepatitis, chronic vascular infections, osteomyelitis, osteoarthritis and chronic pulmonary infections [7]. After 72 hours without improvement, the patient was referred to the emergency department He was febrile at 39.4oC with a maculopapular, non-pruritic, symmetrical exanthem in the axillary region with extension to the inguinal region and hemodynamically stable, eupneic with normal pulmonary auscultation. At bronchofibroscopy the direct examination of bronchoalveolar lavage (LBA) revealed no microorganisms, 2021 Lencastre Monteiro et al Cureus 13(10): e19018. On re-evaluation at three and six months, the patient was asymptomatic with serological IgG antibodies phase I
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
