Coxiella burnetii

Background:

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Atypical Organisms
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>Chlamydophila pneumoniae
>Chlamydophila psittaci
>Coxiella burnetii led
>Legionella species ( L. pneumophila)
>Mycoplasma pneumonia

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Rickettsia
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>Coxiella burnetii led
>Ehrlichia species, Anaplasma
     1] Anaplasma phagocytophilum (Ehrlichia phagocytophilum)
     2] Ehrlichia chaffeensis
     3] Ehrlichia ewingii
     4] Ehrlichia ewubguum
>Others
 
Coxiella burnetii

  • -obligate intracellular bacterial pathogen.
  • -morphologically similar to Rickettsia.
  • -causative agent of Q fever.
  • -small Gram-negative bacterium that is highly resistant to environmental stresses such as high temperature, osmotic pressure, and ultraviolet light.
  • -C. burnetii one of the most infectious known organisms  (infectious dose only 1-10 organisms).
  • -Disease occurs in two stages: an acute stage that presents with headaches, chills, and respiratory symptoms, and an insidious chronic stage.

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Therapy:

Important considerations:  The choice of an agent should be based on local antimicrobial sensitivities, site of infection, cost, and comorbid conditions.   Generally, the most common agents/regimens are listed first.   Listed dosages may need to be adjusted for renal dysfunction. 

  1. Doxycycline 100mg orally twice daily [Range: 100-200mg in 1-2 divided doses]
  2. Bactrim DS (TMP-SMX) 160/800mg po bid
  3. Doxycycline 100mg orally twice daily + hydroxychloroquine
  4. Ciprofloxacin 500-750 mg orally q12h or 200-400mg IV q12h
  5. Moxifloxacin 400mg orally/IV qd
  6. Azithromycin
  7. Clarithromycin 500mg po q12h 
  8. Chloramphenicol 50-100 mg/kg/day in divided doses every 6 hours (Maximum daily dose is 4 grams e.g. 1 gram q6h)

Disclaimer

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