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Document Details :

Title: Hoofdpijn en koorts bij een 35-jarige man
Author(s): HANTSON I, HEREMANS A
Journal: Tijdschrift voor Geneeskunde
Volume: 66    Issue: 22   Date: 2010   
Pages: 1091-1093
DOI: 10.2143/TVG.66.22.2000862

Abstract :
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Headache and fever in a 35-year-old man
A 35-year-old man presented in the emergency room with fever up to 39.5°C, without chills, and with severe headache and nausea since 3 days. The patient denied respiratory symptoms. On admission blood pressure, heart rate, respiratory rate, temperature after antipyretics and oxygen saturation were normal. There were no signs suggestive of meningitis. Pulmonary examination revealed crackles in the left lower dorsal region. C-reactive protein was elevated: 15 mg/dl. Other laboratory findings were normal. The chest X-ray showed a pneumonia in the left lower lobe. Therapy was started with amoxicillin-clavulanate. Only after switching to clarithromycine did symptoms disappear.
What is the diagnosis?
Answer: Coxiella burnetii infection or Q fever, presenting with pneumonia.
Q fever is an acute infectious disease, sometimes associated with a chronic evolution, caused by Coxiella burnetii, an obligate intracellular gram-negative micro-organism.
Following exposure to C. burnetii, a non-immune person develops a primary infection, which is asymptomatic in 60% of cases. Presentation of the disease is extremely variable, ranging from a flu-like self limiting syndrome to severe pneumonia and hepatitis or a chronic infection, manifesting mainly as endocarditis. Cattle, sheep and goats are the primary reservoirs of Q fever for man. Pneumonia is one of the most commonly recognized forms of acute Q fever. It is not uncommon for a variety of extrapulmonary manifestations to be evident at the time of presentation or to appear during the course of the illness. The diagnosis of Q fever is based on serological methods. Acute Q fever usually resolves without treatment within 15 days. Doxycycline, 100 mg twice a day during 14 days, is a recommended treatment.

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