Q fever: symptoms

In contrast to other rickettsiosis, the symptoms of ku-fever are characterized by pronounced polymorphism, which depends on the mechanism of transmission of the pathogen, the infectious dose of rickettsia and the state of the macroorganism. The most severe symptoms of ku-fever occur with aerogenic infection, nevertheless it is a cyclic infection, during which the following periods are distinguished: incubation, initial (3-5 days), high (4-8 days) and convalescence. Ku-fever has the following forms:

• acute (duration of the disease 2-4 weeks) - in 75-80% of patients;
• subacute or prolonged (1-3 months) - in 15-20% of patients:
• chronic (from several months to one year and more) - in 2-30% of patients;
• erased.

Acute, subacute and chronic forms are divided into mild, moderate, heavy and very heavy. Criteria severity - the level of fever, severity of intoxication and organ pathology.

Ku-fever has an incubation period that lasts 3-30 days (an average of 12-19 days).

In 95% of cases, ku-fever has an acute onset: chills, rapid temperature rise to 39-40 ° C and general toxic syndrome. There is a strong, stubborn, non-analgesic diffuse, less often - localized (forehead, nape) headache. Typical symptoms of ku-fever occur: dizziness, weakness, sweating (up to profuse sweat), weakness, arthralgia, myalgia, tenderness in palpation of muscles. From the first days of the disease, the majority of patients observe hyperemia of the face and neck, the injection of vessels of the sclera, hyperemia of the throat. Sometimes note the enanthema, herpes labialis or herpes nasalis, sleep disturbances right up to insomnia. Very characteristic pain in the eye sockets and eyeballs, which increases with their movement. Some patients experience dry cough, nausea, vomiting, nosebleeds, and appetite.

In severe course, such symptoms of fever as fever, delirium are possible. Rarely (1-5% of cases) on the 3rd to 16th day of the disease, there is a rose-or spotted-papular exanthema without permanent localization.

The main and most constant symptom of ku-fever is fever, the duration of which varies from a few days to a month or more (an average of 7-10 days). Usually the temperature reaches 38.5-39.5 ° C. Fever can be permanent, remitting, wrong. Characteristic of its significant fluctuations, detected with a three-hour thermometry (especially in severe and moderate disease). Morning, rather than evening, temperature rises are often more pronounced. The fever is accompanied by chills (probing), sweating throughout the entire disease. The temperature decreases lytically or by the type of truncated lysis for 2-4 days. In some patients, after its reduction, subfebrile is retained, which may be a harbinger of a relapse.

The defeat of the cardiovascular system with ku-fever is not constant and is of little specificity. You can detect muffled heart tones, relative bradycardia, a slight decrease in blood pressure, systolic murmur on the apex of the heart (sometimes). Individual patients with chronic infection may develop a specific rickettsial endocarditis, which is more often noted with the previous rheumatic heart disease and congenital heart diseases. In this case, there are noises, an expansion of the heart's boundaries. Cocky-bearing endocarditis is a chronic process lasting from 5 months to 5 years. In most cases (up to 65%) it ends lethal.

For ku-fever is characterized by the defeat of the respiratory system. There may be tracheitis, bronchitis, pneumonia. The frequency of pneumonia, according to different authors, varies from 5 to 70% and depends on the pathways of infection. They develop mainly with aerogenic contamination; Single cases of pneumonia can be caused by a secondary bacterial infection. Patients complain of coughing (dry, then productive, with viscous serous-purulent sputum), a feeling of discomfort and sadness behind the sternum: sometimes dyspnea occurs. The physical data are meager. You can find areas of shortening of percussion sound, hard breathing, dry, and then wet rales. On the roentgenogram, the intensity of the pulmonary pattern is determined, and the transparency of the pulmonary fields is reduced. Small-focal cone infiltrates, localized mainly in the lower parts of the lungs and the radical zone. These changes are characteristic of interstitial pneumonia. Typically, pneumonic foci are defined as a gentle cloud-like obscuration. Even with the formation of massive blackouts, cavities are not formed, the acute process does not become chronic. With increasing bronchial and paratracheal lymph nodes, the roots of the lungs expand, become denser and deform. Very rarely there is pleuropneumonia with dry pleurisy, so that the disease can take a prolonged or recurrent course. The course of pneumonia is torpid. Resorption of inflammatory foci occurs slowly (within 6 weeks).

On the part of the digestive system, appetite deterioration is noted, with pronounced intoxication - nausea and vomiting; constipation is possible. Some patients complain of such symptoms of fever as flatulence and abdominal pain (due to the defeat of the autonomic nervous system), sometimes strong, of different localization. The tongue is enlarged in volume, overlaid with a dirty gray coating (the edges and tip are clean), with the imprints of the teeth along the edges (similar changes are noted in typhoid fever). Very characteristic is moderate hepato- and splenomegaly. Sometimes reactive hepatitis develops with all its clinical and biochemical features; the outcome is usually favorable. Long-persisting hepatosplenomegaly (after the normalization of temperature) can be observed with prolonged, chronic or recurring disease.

Pathologies from the genitourinary system are usually not detected.

In the period of the height of the disease, the symptoms of ku-fever are often amplified, indicating that the CNS is affected by intoxication. Vegetative disorders are clearly manifested. Possible meningism, serous meningitis, meningoencephalitis, neuritis, polyneuritis, infectious psychosis with delirium and hallucinations. In the period of convalescence, a pronounced psychoasthenic syndrome is usually maintained.

Unusual symptoms of fever: optic neuritis, extrapyramidal disorders, Guillain-Barre syndrome, LDH hypersecretion syndrome, epididymitis, orchitis, hemolytic anemia, enlargement of the mediastinal lymph nodes (the picture resembles lymphoma or lymphogranulomatosis), pancreatitis, erythema nodosum, mesenteritis.

In the study of blood, normo- or leukopenia, neutron and eosinopenia, relative lymphocytosis and monocytosis are noted. A slight increase in ESR. Thrombocytopenia is found in 25% of patients, and thrombocytosis, which reaches 1000x10 ⁹ / l , is often observed upon recovery . This can explain the deep vein thrombosis, often complicating ku-fever. Sometimes it is determined proteinuria, hematuria, cylindruria.

The period of convalescence begins with the normalization of temperature, but already a few days before the patients noted improvement in health, sleep and appetite. In 3-7% of patients, relapses of the disease are recorded 4-15 days after the main wave.

In the period of convalescence, a pronounced psychoasthenic syndrome is often maintained.

Scanty forms are characterized by meager and atypical symptoms. They are found in routine serological studies conducted in the foci of infection.

Perhaps the asymptomatic course of infection in endemic foci and in epidemic outbreaks of disease due to introduction of the causative agent with raw materials (cotton, wool, etc.) into production teams. Positive results of serological tests can be interpreted in different ways: as evidence of asymptomatic infection, a latent infection without clinical symptoms, which can sometimes "break through" protective barriers and cause disease as a result of "pro-epidemic" or "natural immunization" of the population in epidemic outbreaks.

Primary-chronic course of ku-fever is not observed. Usually the ku-fever begins quickly, and then for some reason gets a torpid current. In chronic course, pulmonary or heart lesions predominate, myocarditis, endocarditis). Such forms of infection occur in patients with heart defects, immunodeficiency, chronic renal failure. High fever usually is not present, but subfebrile condition is possible. When a combination of acquired heart defects with a hemorrhagic rash of unspecified etiology or renal insufficiency should be primarily suspected ku-fever. Endocarditis, apparently, has an autoimmune and immunocomplex genesis. Immune complexes are deposited on the valves of the heart valves affected by the infection, or on the growth of the endothelium (especially at the junction of the patient's tissues and prosthetic valves).

Form and course of the disease determines a number of factors. It is known that sporadic incidence of the disease is characterized by good quality. In children, ku-fever occurs more easily than in adults. In infants infected with milk, the clinical course of the disease is the same as in other age groups. A number of infectious diseases have noted a more severe and prolonged course of ku-fever in patients older than fifty years. The combination with other infections (hepatitis, dysentery, amoebiasis, etc.) aggravates the course of the coxicellosis, and the disease itself exacerbates the chronic pathology (tonsillitis, otitis, colitis, etc.).

[1], [2], [3], [4], [5], [6], [7]

Complications of ku-fever

With timely and correctly administered antibiotic therapy, complications of ku-fever are almost absent. In unrecognized cases of ku-fever or with late-onset treatment (especially in chronic course), complications may develop: collapse, myocarditis, endocarditis, pericarditis, deep vein thrombophlebitis of the extremities; lesions of the respiratory system - pleurisy, pulmonary infarction, abscess (with superinfection). Some patients have hepatitis, pancreatitis, orchitis, epididymitis, neuritis, neuralgia, etc.

[8], [9], [10], [11]