On a hot August day in North Carolina, a 35-yearold
Hispanic woman is seen by her primary care
physician for progressive fatigue and a feeling of general
malaise. She informs him that, over the past few
days, she has been noticing difficulty in walking up a
brush-covered slope leading to her home where she
lives in the country, and she suspects she may be
coming down with the flu. She has no history of
chest pain, but did complain of some difficulty in
breathing. She stated that she bruises easily. Apart
from taking ibuprofen fairly regularly, which she purchases over the counter for arthritis, she has not
been on any other any long-term medications. She
had taken one ibuprofen a few hours prior to seeing
her physician. She has no allergies. Physical examination
reveals a moderately built and well-nourished
female who has a low-grade fever and a yellowish
tinge in the sclera. Her vital signs are within normal
limits. She has normal heart sounds and no murmurs,
gallops, or rubs. A few basal rales are present,
but the lungs are clear otherwise. Examination of the
abdomen is unremarkable except for mild tenderness
in the right upper quadrant. She does have mild pitting
edema in the pretibial area. The most likely
cause for her problem is which one of the following?
(A) Lyme disease
(B) West Nile virus
(C) Rocky mountain spotted fever
(E) Q fever
its Q FEVER..i have given this answer by rulling out ther answers
but i am right..here is d explainatio
Q fever is a disease caused by infection with Coxiella burnetii,a bacterium that affects humans and other animals. This organism is uncommon, but may be found in cattle, sheep, goats and other domestic mammals, including cats and dogs. The infection results from inhalation of a spore-like small cell variant, and from contact with the milk, urine, feces, vaginal mucus, or semen of infected animals. Rarely, the disease is tick borne.The incubation period is 9–40 days. A human being can be infected by a single bacterium.The bacterium is an obligate intracellular pathogen.
incubation period is usually two to three weeks.The most common manifestation is mild flu-like symptoms with abrupt onset of fever, malaise, profuse perspiration, severe headache, myalgia (muscle pain), joint pain, loss of appetite, upper respiratory problems, dry cough, pleuritic pain, chills, confusion and gastrointestinal symptoms, such as nausea, vomiting and diarrhea. The fever lasts approximately seven to 14 days.
Approximately half of infected individuals exhibit no symptoms.
During the course, the disease can progress to an atypical pneumonia, which can result in a life-threatening acute respiratory distress syndrome (ARDS), whereby such symptoms usually occur during the first four to five days of infection.
Less often, Q fever causes (granulomatous) hepatitis, which may be asymptomatic or becomes symptomatic with malaise, fever, liver enlargement (hepatomegaly) and pain in the right upper quadrant of the abdomen. Whereas transaminase values are often elevated, jaundice is uncommon. Retinal vasculitis is a rare manifestation of Q fever.
The chronic form of Q fever is virtually identical to inflammation of the inner lining of the heart (endocarditis), which can occur months or decades following the infection. It is usually fatal if untreated. However, with appropriate treatment, the mortality falls to around 10%.
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