A 21-year-old man comes to the emergency department due to shortness of breath, fatigue, myalgias, and debilitating retroorbital headaches for the past several days. The patient is on summer break and came to work at his grandparents' dairy farm 3 weeks ago. He cleans out animal waste from the barn, but he does not handle hay. His past medical history is insignificant. He does not use tobacco or illicit drugs. The patient's temperature is 38.8 C (101.8 F). Bronchial breath sounds are heard in the right lower lung. There are no cardiac murmurs. Abdominal examination is unremarkable. Chest x-ray demonstrates right lower and middle lobe consolidation. Laboratory results are as follows: An HIV test is negative.Which of the following is the most likely cause of this patient's symptoms?

Question

A 21-year-old man comes to the emergency department due to shortness of breath, fatigue, myalgias, and debilitating retroorbital headaches for the past several days.  The patient is on summer break and came to work at his grandparents' dairy farm 3 weeks ago.  He cleans out animal waste from the barn, but he does not handle hay.  His past medical history is insignificant.  He does not use tobacco or illicit drugs.  The patient's temperature is 38.8 C (101.8 F).  Bronchial breath sounds are heard in the right lower lung.  There are no cardiac murmurs.  Abdominal examination is unremarkable.  Chest x-ray demonstrates right lower and middle lobe consolidation.  Laboratory results are as follows:  An HIV test is negative.Which of the following is the most likely cause of this patient's symptoms?

Quizplus · Accepted Answer

Eductional Objective: Q fever is a zoonotic infection that occurs in farm workers exposed to waste from cattle and sheep.  Its causative agent is Coxiella burnetii.  A patient with exposure to waste from farm animals who develops a nonspecific illness (myalgias, fatigue, fever [>10 days], retroorbital headache) with a normal leukocyte count, thrombocytopenia, and increased liver enzymes should be evaluated for acute Q fever infection.

A 21-Year-Old Man Comes to the Emergency Department Due to Shortness