Necropsy Findings in a Case of Q Fever in Britain

Abstract

[WITH SPECIAL PLATE] Q fever, first described by Derrick (1937) HistologyLung.-Sections from the red and grey areas of the diffusely consolidated right lower lobe showed differences due to stages .in the pneumonic process. In the red area, consolidation was not uniform, the exudate within alveoli having a patchy distribution. Throughout there was intense congestion of blood -vessels. Alveoli were filled with an eosinophil non-fibrillary coagulum in which were a few cells. These consisted of neutrophilic polymorphs and round cells in about equal numbers; red corpuscles were scanty, and were present at only a very few points. The round cells were of different types. A few were lymphocytes and plasma cells, but most were larger mononuclear macrophages which, owing to degenerative changes, -varied in appearance from elements of about plasma-cell size with well-stained cytoplasm and dark nuclei to large pale cells with finely granular or vacuolated cytoplasm and vesicular, often peripheral, nuclei; The vacuolated appearance was striking, and was-not due to the presence of lipoid: the contents of the vacuoles failed to stain with Sudan 111 and were not doubly refractile. The exudate within bronchioles was similar to that in the alveoli, though in and about some respiratory bronchioles there was a higher concentration of neutrophilic polymorphs. There was some oedema of interlobular connective tissues and of the walls of blood vessels within them.In the basal zone of grey hepatization the pneumonic process was more uniform. Here there was little congestion. The alveolar walls were considerably thickened (Plate, Fig. 1), through infiltration by many macrophages and smaller numbers of lymphocytes, plasma cells, and neutrophils. In some there was also early fibroblastic proliferation. Scattered areas showed necrosis and breakdown of septa. Within the alveoli the exudate was cellular (Fig. 2) Brain.-In the foci of cerebral and pontine softening the tissues showed both perivascular and more widespread loosening of texture with occasional small'perivascular haemorrhages (Fig. 4). Some of the capillary vessels showed swelling of their endothelium and a few contained thrombi. No perivascular cellular exudate was present in the affected areas, but there was slight marginal increase of neuroglial cells, and these, with Giemsa staining, contained many cytoplasmic granules. Some of the granules were coarse and irregular in shape and were probably degenerative products, the result of clasmatodendrosis, but others were morphologically, and in their grouping, rickettsiae. Support for their identification as rickettsiae was provided by the' presence of similar bodies in the cytoplasm of some capillary endothelial cells as well as extracellularly in the damaged areas. The same problem has arisen in typhus, and the criteria applied by Wolbach et al. (1922), similar to those given here, appear to be valid. The nervous lesions were probably at a very early stage of development.Spleen.-The Malpighian bodies were very small, and the pulp ...

The Infectious Dose ofCoxiella Burnetii(Q Fever)

“…At the same time, C. burnetii have been visualized by light microscopy in the expectorant of Q fever patients, and presence of the organism in sputum is used for early diagnosis of Q fever (Steinmann, 1951). The presence of C. burnetii in the sputum is consistent with the observation of large numbers of rickettsiae in the pulmonary alveoli postmortem (Whittick, 1950). The incidence of Q fever in the context of autopsy (Harman, 1949;Gerth, Leidig, & Riemenschneider, 1982) and parturition (Ludlam et al, 1997;Syrucek, Sobeslavsky, & Gurvirth, 1958) also indicates that viable C. burentii are present in other body tissues including placental blood and amniotic fluid, as has been observed in guinea pig tissues (Parker, 1943).…”

“…The organism is present in lungs (Whittick, 1950) and respiratory excretions (Steinmann, 1951) of at least some patients. Coughing is associated with some proportion of Q fever cases and emits many particles of respiratory fluid that quickly attain diameters less than 100 m; these particles can be inspired and, depending on particle aerodynamic diameter, deposit in the alveolar region or upper respiratory tract.…”

Q Fever

“…Organ biopsies are no longer performed for Q fever diagnosis which may be established accurately by serological methods. Typical pulmonary histopathological lesions in patients with Q fever pneumonia correspond to a gross consolidation, microscopic interstitial pneumonia, and alveolar exudates (189,268,412). Interstitial infiltrates are composed of mostly macrophages and lymphocytes and to a lesser extent polymorphonuclear leukocytes (161,268).…”

Invasion of the Central Nervous System by Intracellular Bacteria

“…C. burnetii is difficult to culture from the CSF but has been identified by PCR in one patient (338). One necropsy of a patient who died of Q fever pneumonia showed small perivascular hemorrhages in the brain, with capillary endothelial swelling without perivascular accumulation of leukocytes (406). Rickettsial forms were identified extracellularly and inside neuroglia and endothelial cells by Giemsa staining.…”