Thursday, May 9, 2013


You get called by a public health department in Nova Scotia (or Switzerland, Great Britain, Germany, or southern France). They're wondering if you can help because a number of their sheep and goats have had spontaneous abortions, and some of their cattle have had low birthweight offspring.

"Um...," you say.

Well, they also want your opinion because a few of the farm workers and veternarians have come in sick. Most are men between 30-70 years of age. Some have presented with a self-limited flu-like illness with an abrupt high-grade fever, fatigue, headache, and myalgias. Others have presented with a mild nonproductive cough, fever, and a CXR shown below (A is normal, B is the patient).

Yet others present with hepatomegaly, fever, and increased LFTs. For most patients, the CBC is normal.

Here is the organism:

Challenge: What's your diagnosis?

Both images are in the public domain.


Anonymous said...


Craig Chen said...

nice idea - brucellosis definitely has the same epidemiology as a zoonotic livestock disease, but I was going for q fever.

This is Q fever, a zoonotic infection caused by Coxiella burnetii.

Sources: UpToDate; Wikipedia.