188.4 📌 章末速蚘

  • Coxiella burnetii — obligate intracellular, spore-like resistance, bioterror Cat B
  • Reservoir: 家畜 (cattle, sheep, goats — birth fluids #1 infectious)
  • Aerosol transmission (very infectious, 1 organism), not p2p
  • Acute Q fever: 急 fever + severe headache + pneumonia + hepatitis (“doughnut granuloma”), 2 wk self-limit
  • Chronic Q fever: culture-negative endocarditis (#1), vascular infection, QFS
  • Risk for chronic: pre-existing valve, vascular graft, immunocompromise, pregnancy
  • Dx: serology Phase I vs II (chronic Phase I > II); PCR for tissue
  • Tx acute: doxy 100 bid × 14d
  • Tx chronic: doxy + HCQ ≥ 18 mo (valve), ≥ 24 mo (vascular)
  • Pregnancy acute: TMP-SMX × until delivery
  • Pre-existing valve disease + chronic fever + culture-neg → consider Coxiella (and Bartonella, Brucella)