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| Q-FEVER! |
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CASE STUDY
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Our patient is a 54 year old man who is a race horse trainer.In 1999 he
presented with recurrent anaemia, weight loss, listlessness, portal
hypertension, enlarged liver, some degree of ascites and a history of severe
malaria.
Cirrhosis of the liver was the provisional diagnosis.
In 2001, our patient presented with melaena stools and haematemesis. A
laparoscopy was performed and cirrhosis was again the diagnosis. Serological
blood tests were then done and a diagnosis of Q fever was made.
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In 2004 our patient presented with melaena stools and haematemesis. A
gastroscopy was done and oesophageal varices were observed beginning at
30cms and extending to the area around the gastro-oesophageal junction.
These were banded. He returned a week later and the remaining oesophageal
varices were electively banded. He then proceeded to have a couple more
incidents of active bleeding and banding followed by elective banding.
This year our patient has also had a couple of incidents of haematemesis and
bandings, electively as well as when actively bleeding.
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On the 22/7/05 this patient again presented with melaena stools and haematemesis.
The same patient had a subsequent bleed on 31/7/05. Again six bands were applied to the oesophageal varices and once more electively a week later.
On the 19/8/05 this patient arrived in casualty with severe
haematemesis once again. We did a gastroscopy on him and were able to visualize his previously banded oesophageal varices. These appeared not to be actively bleeding.
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The stomach had a great deal of blood and food in it so we were unable to see if he had gastric hemorrhage. The doctor then inserted a sengstaken tube and sent the patient to ICU where he was
haemodynamically resuscitated. The tube was removed after 36 hours and then we once again did a gastroscopy. This patient had large areas of ulceration in the stomach, which had been hemorrhaging. The doctor discussed the possibility of surgery with the patient.
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Q fever is a rare bacterial infection by the coxiella burnetii microorganism. It is thought to be transmitted to man from parturient animals, typically sheep. A specific diagnosis is easily made by serologic testing. The majority of patients infected with coxiella burnetii are either asymptomatic or experience mild disease. Only a few patients experience
complications leading to hospitalization and fatal diseases are extremely rare.
The incubation period may last from 2 to 3 weeks. In symptomatic patients the onset is abrupt with severe fever, fatigue chills and headache. Atypical pneumonia, a
granulomatous hepatitis and endocarditis are manifestations of Q fever. In Q fever the involvement of the liver is frequently associated with endocarditis. Only a few cases of chronic hepatitis without endocarditis have been recorded.
The disease is usually mild and resolves spontaneously within 2 to 3 weeks. Treatment of coxiella burnetii infection is complex. It is based on prolonged antibiotic regimens
because of frequent relapses. Combinations of doxycycline and quinolones are usually successful.
Jaye Krane |
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