title: Clinician assessment for Coxiella burnetii infection in hospitalized patients with potentially compatible illnesses during Q fever outbreaks and following a health alert, Montana, 2011.
abstract: BACKGROUND
  Coxiella burnetii is an endemic bacterial pathogen in the United States and the causative agent of Q fever. Two outbreaks of Q fever occurred in Montana during 2011, which led to the issuance of a health alert urging clinicians to test patients with Q fever-compatible illnesses for C. burnetii infection.
  
  
  METHODS
  We retrospectively evaluated the medical records of patients hospitalized for fever, pneumonia, chest pain, and viral infection of unknown etiologies during the two Q fever outbreaks and following the health alert.
  
  
  RESULTS
  A total of 103 patients were included in the analysis. Clinicians assessed<1% of patients suffering illnesses compatible with Q fever for known risk factors or C. burnetii infection. Only 1 patient had Q fever excluded as a diagnosis.
  
  
  CONCLUSIONS
  Clinicians should assess for Q fever risk factors and consider the diagnosis in patients hospitalized with Q fever-compatible illnesses when the etiology of illness is unknown. Work is warranted to evaluate the effectiveness of current healthcare alert practices for zoonotic diseases.
authors.affiliation: Career Epidemiology Field Officer Program, Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA. ggE5@cdc.gov
authors.forename: Randall J
authors.initials: RJ
authors.lastname: Nett
authors.forename: Steven D
authors.initials: SD
authors.lastname: Helgerson
authors.forename: Alicia D
authors.initials: AD
authors.lastname: Anderson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents; D016997:Coxiella burnetii; D004196:Disease Outbreaks; D019353:Endemic Diseases; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009009:Montana / Q000453:epidemiology; D011778:Q Fever / Q000453:epidemiology / Q000382:microbiology*; D012189:Retrospective Studies; D012698:Serologic Tests; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents