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Introduction Query fever is a natural epidemic infection caused by systemic infections caused by coxiella burnetii, also known as cox's disease. Livestock such as cattle, sheep, dogs, horses, donkeys and pigs are the main source of infection. Clinical features are fever, headache, and generalized muscle pain; but no rash, sometimes with interstitial pneumonia, and a small number of patients with chronic hepatitis or fatal endocarditis. Founded in 1935 by Derrick et al. at a slaughterhouse in Queensland, Australia. Doing the relevant preventive measures can effectively prevent the disease from happening.

Cause

The beakkox body, also known as the Rickettsia query, has a size of about 0.2 to 0.4 m × (0.4 to 1.0 m) and is in the shape of a club or a short rod and has a filter property. Its genomic molecular weight is 1.04 × 109, including 1.6 × 106 bp, which is about 1/3 of Escherichia coli. In recent years, it has isolated 13 genes, which are related to the encoding of rickettsial metabolic enzymes, such as pyrB, gltA, sdhCDAB genes; or related to coding surface antigens, such as tpA, tpB, comI genes; Related to force factors, such as sod, mucz, cbbE, dnaJ, qrsA genes. In addition, it has been found that the chicordrox has four different plasmids, QpH1 (36 kb), QpRS (39 kb), QpDV (33.5 kh) and QpDG (51 kb), the function of which has not yet been elucidated.

The Benacox body has a phenomenon of antigen phase variation, which is due to adaptation to different hosts and exhibits two-phase antigenicity, mainly LPS mutation. The newly isolated Cox body from human, animal or scorpion is phase I, contains intact antigen component, has smooth Lps (IPSI), and has strong virulence; if it is artificially passaged several times through chicken embryo yolk sac, it is A phase II attenuated strain containing rough Lps (LPSII). Most patients with fever are infected with phase II hot cox, and infection with phase I hot cox is easy with endocarditis.

Benackox has strong resistance to the outside world, can live for 6 months in dry blood, can survive for 2 years in dry manure, and needs to be boiled for more than 10 minutes in milk to be killed. It is highly contagious and can infect humans without using arthropods as a medium of transmission. It can spread through aerosols and is a highly contagious pathogen that can cause laboratory infections. There was no cross-immunization between the hot-spotted Cox body and the Proteus, and the infected patient's external-Fiji reaction was negative.

an examination

1. Blood routine and biochemical examination

Peripheral blood leukocyte counts are mostly in the normal range, neutrophils may be slightly elevated, erythrocyte sedimentation rate is moderately increased, and acute or chronic sputum fever may increase alanine aminotransferase and aspartate aminotransferase, serum Elevated bilirubin is rare, and chronic sputum fever may cause abnormalities in myocardial zymogram.

2. Serum immunology and pathogen examination

(1) Negative reactions were observed in Proteus OXk, OX19 and OX2 agglutination tests.

(2) Complement binding test: antibody titer 1:81:10 is the positive minimum titer, and repeated detection once after 1 week, if the titer is increased by more than 4 times, it may have diagnostic significance.

(3) Anthrax Cox agglutination test: The antibody titer has a diagnostic significance from 1:16 to 1:512.

(4) Indirect immunofluorescence assay: An increase in the antibody to the Rickettsia phase II phase indicates the recent exposure or acute type of hot, hot-spotted Kirk-body I phase antibody titration, IgG>1:800 and:IgA>1:50 Or the level of I phase antibody is higher than that of phase II, suggesting chronic type of fever.

(5) Animal inoculation: 2 to 3 ml of blood of a fever patient is inoculated into the abdominal cavity of a guinea pig. After the guinea pig is heated, the spleen cell suspension is inoculated into the testicle of a normal guinea pig. The guinea pig is anatomized after 7 to 10 days of fever, and the testicular parenchyma is visible. Hot Cox body, has a diagnosis.

3. Imaging examination

(1) X-ray examination: It can be found that there is inflammation in the lungs, and there are segmental or large-leaf blurred shadows around the lower lobe of the lungs. It can also be thickened and infiltrated around the hilum or bronchi.

(2) B-mode ultrasound examination: chronic sputum fever can be found in the liver and spleen.

Differential diagnosis

Acute heat should be differentiated from diseases such as influenza, typhoid, leptospirosis and mycoplasmal pneumonia. Chronic heat should be differentiated from diseases such as brucellosis, chronic viral hepatitis, and rheumatic heart disease.

1. Epidemiological basis: The local area is hot and popular. There are close contact with cattle, sheep and other livestock, drinking contaminated water or infected animal dairy products, and direct contact with sick animal manure, urine, amniotic fluid, placenta and fur, all have auxiliary diagnostic significance. Workers in slaughterhouses, meat processing plants, milk factories, various animal husbandries and tanneries are at high risk.

2. Clinical manifestations: fever, headache, muscle pain, chest pain, cough, no rash is a common manifestation of acute type of fever. Long-term fever, fatigue, weight loss, joint pain, hepatosplenomegaly, and heart murmur are common manifestations of chronic fever.

3. Laboratory and special examination: peripheral blood leukocytes are normal, neutrophils are high, erythrocyte sedimentation rate is increased, liver function and cardiac function are abnormal, external-fibe reaction is negative, X-ray lung has inflammation changes, B-mode ultrasound has liver Splenomegaly has an auxiliary diagnostic value. The serological examination titer reached the diagnostic criteria or the animal was positive for the isolation of the rickettsia culture.

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