MOFFITT AM REPORT PEARLS 6/29/16: Toxidromes and Q fever!

Toxidromes: A reminder!

Sympathomimetic: Agitated, mydriasis, febrile/tachy/HTN (wide pulse pressure), diaphoretic

E.g. Cocaine, amphetamines

Anticholinergic: Agitated, mydriasis, febrile/tachy/HTN, dry as a bone, red as a beet, mad as a hatter, urinary retention, decreased bowel sounds

E.g. Tricyclics, scopolamine, antihistamines

Cholinergic: Confusion/coma, miosis, brady, salivation, urinary/fecal incontinence, emesis, lacrimation

E.g. Organophosphates

Opioid: CNS depression, miosis, hypothermia, brady, apnea, hyporeflexia

E.g. …opioids…

Sedative-hypnotic: CNS depression, hypothermia, brady, apnea, hyporeflexia

E.g. Benzos, barbiturates, alcohol, zolpidem

Hallucinogen: Hallucinations! Agitation, mydriasis, febrile/tachy/HTN, nystagmus

E.g. LSD, PCP, amphetamines


Atypical Multisystemic Bacterial Infections: Think the “3 Ellas!”

– Bartonella

– Brucella

– Coxiella (Q Fever)


Atypical Pulmonary Bacterial Infections:

– Chlamydia pneumoniae

– Mycoplasma pneumoniae

– Legionella pneumophila

Q Fever is far down the list!


Q Fever:

Acute infection: self-limited, flu-like, pneumonia, or hepatitis. Incubation period = 2-5 weeks

Chronic (“persistent localized”) infection: Can follow acute or asymptomatic infection in 1-5% of patients. More likely in pregnant or immunocompromised patients, or underlying valvular/vascular disease or prosthetic joint.

  • Endocarditis (most common!)
  • Infected aneurysm or vascular graft
  • Bone/joint infections

Primary exposure is farm animals or being downwind from a farm.

Dx with serologic testing (immunofluorescence), PCR if neg ab testing and high suspicion.

  • C. burnetii does not grow in routine blood cultures!

All patients with acute Q fever should have TTE.

Tx for acute Q fever: Doxycycline x 14 days (reduces symptom duration)

  • f/u testing at 3 and 6 months to confirm resolution
  • TMP-SMX in pregnancy
  • Treat for 1 year and add hydroxychloroquine if underlying valvulopathy or cardiomyopathy to prevent endocarditis!

Tx for persistent localized infection: Doxycycline + hydroxychloroquine x 18 months!

20% of patients develop post-Q fever fatigue syndrome, treatment is supportive.

Q fever vaccine? Effective in Australia, available in U.S. but not licensed (few human studies).




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