An unusual presentation of a known condition: Q fever manifesting as an acute abdomen


An unusual presentation of a known condition: Q fever manifesting as an acute abdomen


Elisabeth Ng1 and Tunde Ibrahim2
1Department of Medicine, Alfred Health, Victoria, Australia
2Department of Medicine, Goulburn Valley Health, Victoria, Australia


International-Journal-of-Case-Reports-2d code

Q fever is an endemic zoonotic infection in Australia cause by Coxiella burnetii. It has been recognised in other parts of the world, especially among livestock rearing occupations, stock yard and abattoir workers. Majority (65%) of patients infected with C.burnetti are asymptomatic while symptoms similar to those of respiratory and hepatitis are the most common making diagnosis difficult in the early stages.
We report a case of a young man who was exposed to and infected with Q fever as an occupational hazard. He presented in an unusual way with the predominant initial symptoms of abdominal pain, fever, hepatitis and sterile peritonitis necessitating an emergency surgical procedure to explore a suspected surgical abdomen. Respiratory involvement ensued only several days later. The diagnosis of Q fever was confirmed with positive convalescent serology phase II IgM and IgG antibodies to Coxiella burnetii. A marked clinical response to doxycycline pending serological confirmation was supportive of this highly suspected diagnosis in an at-risk patient.


Keywords: Q fever, acute abdomen


Free Full-text PDF


How to cite this article:
Elisabeth Ng and Tunde Ibrahim. An unusual presentation of a known condition: Q fever manifesting as an acute abdomen. International Journal of Case Reports, 2019 4:59. DOI: 10.28933/ijcr-2019-01-0506


References:

1. Eastwood K, Massey PD, Hutchinson P, et al. Q fever: A rural disease with potential urban con-sequences. Aust J Gen Pract. 2018;47(3):5555
2. Goyette M, Bouchard J, Poirier A, et al. Importance of Q fever in community acquired pneumo-nia. Can J Infect Dis. 1996; 7(6): 370–373.
3. Graves SR, Islam A. Endemic Q fever in New South Wales, Australia: a case series (2005-2013). Am J Trop Med Hyg. 2016;95:55–9.
4. Raoult D, Marrie T. Q fever. Clin Infect Dis. 1995;20(3):489-495.
5. Bacci S, Villumsen S, Valentiner‐Branth P, et al. Epidemiology and clinical features of human infection with Coxiella burnetii in Denmark during 2006–07. Zoonoses Public Health. 2012; 59(1), 61–68.
6. Bernit E, Pouget J, Janbon F et al. Neurological involvement in acute Q fever: a report of 29 cases and review of the literature. Arch Intern Med. 2002;162(6):693.
7. Jang YR, Song JS, Jin CE, et al. Molecular detection of Coxiella burnetii in heart valve tissue from patients with culture-negative infective endocarditis. Medicine (Baltimore). 2018;97(34):e11881.
8. Anderson A, Bijlmer H, Fournier PE, et al. Diagnosis and management of Q fever – United States, 2013: Recommendations from CDC and the Q Fever Working Group. MMWR Recomm Rep. 2013;62:1-23.
9. Hartzell JD, Wood-Morris RN, Martinez LJ, Trotta RF. 2008. Q fever: epidemiology, diagnosis, and treatment. Mayo Clin. Proc. 83:574–579. 10.4065/83.5.574.
10. Lindsay PJ, Rohailla S, Miyakis S. Q Fever in Rural Australia: Education Versus Vaccination. Vector Borne Zoonotic Dis. 2018 Nov;18(11):632-634.