The radiological appearances of ‘Q’ fever pneumonia

doi:10.1016/S0009-9260(05)80857-8

Clinical Radiology

Volume 44, Issue 3, September 1991, Pages 150-153

https://doi.org/10.1016/S0009-9260(05)80857-8 Get rights and content

The chest film findings in a series of 21 cases of serologically proven ‘Q’ fever with radiological evidence of pneumonia were reviewed retrospectively. Segmental opacities which were slow to clear, often with loss of volume and sometimes lobar consolidation, were the most usual findings. Lesions were occasionally multiple and sometimes became rounded during resolution. The appearances were not considered sufficiently distinctive to allow the diagnosis to be made in the acute phase of the illness, although the appearance of round pneumonias which are slow to resolve should alert the radiologist to this possible diagnosis. The findings are discussed in relation to previously reported series.

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Cited by (16)

Chest CT findings in community-acquired pneumonia due to Coxiella burnetii (Q fever) compared to Streptococcus pneumoniae, a cross sectional study in French Guiana, 2013–2017
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Few and small studies previously examined chest CT-scan characteristics of Coxiella burnetii (Cb) community-acquired pneumonia (CAP). Larger studies are needed to guide physicians towards diagnosis of Q fever in case of pneumonia.
We conducted a single-center retrospective observational study between 2013 and 2017. All patients with Cb or Streptococcus pneumoniae (Sp) CAP who had a chest CT-scan on admission at Cayenne Hospital (French Guiana) were included. Chest CT-scan were all analyzed by the same expert radiologist.
We included 75 patients with Cb CAP and 36 with Sp CAP. Fifty-nine percent of all patients were men (n = 66) and median age was 52 [IQR = 38–62]. Chest CT-scans of Cb CAP patients revealed 67 alveolar condensations (89 %), 52 ground-glass opacities (69 %), 30 cases of lymphadenopathy(ies) (40 %) and 25 pleural effusions (33 %). Parenchyma lesions caused by Cb were predominantly unilateral (67 %). We found high numbers of alveolar condensations in both Cb and Sp CAP (89 % and 75 %; respectively), but the presence of ground-glass opacities was significantly associated with Cb CAP (69 % versus 30 %; p < 0.01). Cb CAP were associated with more lymphadenopathies (40 % vs 17 %; p = 0.01) while Sp CAP showed more bronchial thickening (19 % versus 3 %; p < 0.01) and (micro)nodule(s) ≤1 cm (25 % vs 3 %, p < 0.01).
This large study shows that the most typical aspect of chest CT-scan in case of Cb CAP in French Guiana is a unilateral alveolar consolidation associated with ground glass opacities and lymphadenopathies. C. burnetti and S. pneumoniae both most often cause alveolar consolidations, but present some significantly different CT-scan patterns. This could help physicians through therapeutic choices.
Pneumonia in the Immunocompromised Host
2022, Seminars in Roentgenology
Citation Excerpt :
Coxiella pneumonia is associated with consolidation on radiographs, which is frequently multifocal with no predilection for specific lung zones. Prior retrospective studies have found consolidation with a rounded shape which is juslow to resolve.19,20 CT findings also demonstrate a patchy, segmental or lobar distribution of consolidation.
Pneumonia in the immunocompromised host can be devastating and can result from both common and opportunistic organisms. This paper examines the imaging findings in mostly opportunistic organisms which cause pneumonia in the immunocompromised host. Some organisms, such as tuberculosis, non-tuberculous mycobacteria, and influenza will also be discussed because although they are not specifically opportunistic, they can result in extensive and devastating disease in immunocompromised patients. It is important for the radiologist to recognize unique imaging findings in pneumonia in the immunocompromised patient and raise the possibility of certain organisms to direct appropriate therapy.
Severe Q fever community-acquired pneumonia (CAP) mimicking Legionnaires' disease: Clinical significance of cold agglutinins, anti-smooth muscle antibodies and thrombocytosis
2009, Heart and Lung: Journal of Acute and Critical Care
Citation Excerpt :
Although the patient denied a recent history of fly bites, had no direct contact with parturient cats, and had no contact with animal/animal products, she did admit that her neighbors had cats, but none were recently parturient. The clue to Q fever CAP was not epidemiologic but clinical, that is, “round pneumonia” on chest CT scan and mild hepatomegaly.2,17-19 These findings prompted us to order Q fever serology.
Atypical community-acquired pneumonia (CAP) may be caused by zoonotic or nonpulmonary pathogens. However, atypical pathogens are systemic infectious disease accompanied by pneumonia in contrast with typical bacterial pathogens with infection limited to the lungs and absent extrapulmonary findings. Clinically and radiologically, the atypical CAP pathogens that most closely resemble each other are psittacosis, Q fever, and Legionnaires' disease. Psittacosis can usually be readily suspected or eliminated on the basis of a recent psittacine bird contact history. The 2 atypical pneumonias that most closely resemble each other clinically are Q fever and Legionnaires' disease. The epidemiology of Q fever is related to livestock, and sporadic cases are related to contact to parturient cats. In nonendemic areas, Q fever CAP mimics Legionnaires' disease most closely. Both Q fever and Legionella CAP have several clinical and laboratory features in common. However, there are subtle but important differences that allow the astute clinician to differentiate between these 2 disorders on the basis of clinical and nonspecific laboratory findings before definitive diagnostic tests results are reported. We report a case of severe Q fever CAP mimicking Legionnaires' disease in a young adult normal host. Her initial zoonotic contact history was negative, and her clinical presentation suggested Legionnaires' disease as the most likely diagnosis. Against the diagnosis of Legionnaires' disease was the patient's age and occurrence of the disease in spring time. In contrast, Legionnaires' disease is usually an infection of older individuals and occurs in late summer/fall. Although the patient did not have splenomegaly, a common finding in Q fever CAP, she did have mild hepatomegaly. Hepatomegaly is a uncommon in Q fever CAP but is not a feature of Legionnaires' disease. In the absence of a positive zoonotic contact history, the cardinal findings pointing to the diagnosis of Q fever in this case were “multiple round opacities” on chest computed tomography scan and thrombocytosis during her hospitalization. Against the diagnosis of Legionnaires' disease was the absence of hypophosphatemia and highly elevated ferritin levels. In patients with atypical pneumonias in whom the clinical presentation and nonspecific laboratory findings suggest Legionnaires' disease, but in addition have findings not associated with Legionnaires' (eg, hepatomegaly, thrombocytosis), Q fever serology should be ordered. We conclude that Q fever may closely mimic Legionnaires' disease. Severe atypical CAP with “multiple round opacities” on chest x-ray/computed tomography chest scan with elevated anti-smooth muscle antibodies or thrombocytosis should suggest the diagnosis of Q fever and prompt specific testing for Q fever. Rarely, Q fever CAP may be associated with elevated cold agglutinin titers.
A frequent error in etiology of round pneumonia [7]
2004, Chest
Q fever: A biological weapon in your backyard
2003, Lancet Infectious Diseases
Citation Excerpt :
Loss of volume and lobar consolidation can be seen. Lesions at times are multiple and become round during resolution.104 Linear atelectasis is not common, but in one study atelectasis was seen more frequently in Q fever than in other atypical pneumonias.105
Coxiella burnetii, which causes Q fever, is a highly infectious agent that is widespread among livestock around the world. Although the culture process for coxiella is laborious, large amounts of infectious material can be produced. If used as an aerosolised biological weapon, coxiella may not cause high mortality, but could provoke acute disabling disease. In its late course, Q fever can be complicated by fatal (eg, ndocarditis) or debilitating (eg, chronic fatigue syndrome) disorders. The diagnosis of Q fever might be delayed because of non-specific and protean presentations. Effective antibiotic treatment is available for the acute form of disease but not for the chronic complications. Vaccination and chemoprophylaxis in selected individuals may be used in the event of bioterrorism.
Q fever-A review and issues for the next century
1997, International Journal of Antimicrobial Agents

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Original PaperThe radiological appearances of ‘Q’ fever pneumonia

Journal of the Canadian Association of Radiologists

Radiology

British Medical Journal

Epidemiology and Infection

Rontgenbild und Verlaufsbeobachtungen bei Q Feiber Pneumonien

Fortschritte auf dem Gebiete der Roentgenstrahlen und der Nuklearmedizin

Q fever, a new fever entity: clinical features diagnosis and laboratory investigation

Medical Journal of Australia

Reviews of Infections Diseases

Chronic or fatal Q fever infection: a review of 16 patients seen in north-east Scotland (1967–80)

Quarterly Journal of Medicine, New Series L11

Q fever

British Medical Journal

Original Paper
The radiological appearances of ‘Q’ fever pneumonia