Many patients exposed to Coxiella burnetii develop a subclinical or mild self-limited disease. A person with one or more risk factors is more likely to develop significant acute or chronic Q fever.
Possible mechanisms:
(1) defective host defenses during acute disease
(2) damaged organ predisposed to infection
(3) reactivation or persistence of latent infection
Risk factors associated with significant disease:
(1) male gender
(2) pregnant female (associated with decreased cell-mediated immunity in the third trimester)
(5) valvular heart disease (native valve or prosthesis)
(6) arterial aneurysm
(7) vascular graft
(8) COPD or chronic bronchitis
(9) alcoholism
Q fever should be suspected if a person with one or more of these risk factors has a fever of unknown origin, unexplained hepatitis or culture negative endocarditis.
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