贝氏柯克斯体感染

越来越重要的急性贝氏柯克斯体感染的并发症，会导致长期残疾；然而，尚不清楚这种并发症的发生机制。[60]Wildman MJ, Smith EG, Groves J, et al. Chronic fatigue following infection by Coxiella burnetii (Q fever): ten-year follow-up of the 1989 UK outbreak cohort. QJM. 2002;95:527-538.http://qjmed.oxfordjournals.org/content/95/8/527.longhttp://www.ncbi.nlm.nih.gov/pubmed/12145392?tool=bestpractice.com[61]Ayres JG, Wildman M, Groves J, et al. Long-term follow-up of patients from the 1989 Q fever outbreak: no evidence of excess cardiac disease in those with fatigue. QJM. 2002;95:539-546.http://qjmed.oxfordjournals.org/content/95/8/539.longhttp://www.ncbi.nlm.nih.gov/pubmed/12145393?tool=bestpractice.com

约有10%的患者发生。

在急性感染后约6个月出现。

慢性疲乏综合征

心内膜炎是最常见的持续性感染（60% 至 70% 的病例）。[2]Hartzell JD, Wood-Morris RN, Martinez LJ, et al. Q fever: Epidemiology, diagnosis, and treatment. Mayo Clin Proc. 2008;83:574-579.http://www.mayoclinicproceedings.org/article/S0025-6196(11)60733-7/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/18452690?tool=bestpractice.com

停用抗生素后症状可复发，因此建议长期治疗（至少18个月）。

重症心脏衰竭是感染性心内膜炎的潜在并发症。

感染性心内膜炎

孢子可以在妊娠期间被再激活，诱发多种并发症，包括自然流产、胎儿死亡和胎儿畸形。[51]Baud D, Greub G. Intracellular bacteria and adverse pregnancy outcomes. Clin Microbiol Infect. 2011:17;1312-1322.http://www.ncbi.nlm.nih.gov/pubmed/21884294?tool=bestpractice.com[4]Million M, Roblot F, Carles D, et al. Reevaluation of the risk of fetal death and malformation after Q fever. Clin Infect Dis. 2014;59:256-260.http://cid.oxfordjournals.org/content/59/2/256.longhttp://www.ncbi.nlm.nih.gov/pubmed/24748522?tool=bestpractice.com

产科医生必须警惕患者的症状，特别是之前患有贝氏柯克斯体感染。

在妊娠早期获得的贝氏柯克斯体感染可导致自然流产、胎儿死亡、胎儿畸形、生长迟缓、羊水过少或早产。[51]Baud D, Greub G. Intracellular bacteria and adverse pregnancy outcomes. Clin Microbiol Infect. 2011:17;1312-1322.http://www.ncbi.nlm.nih.gov/pubmed/21884294?tool=bestpractice.com[94]Langley JM, Marrie TJ, Leblanc JC, et al. Coxiella burnetii seropositivity in parturient women is associated with adverse pregnancy outcomes. Am J Obstet Gynecol. 2003;189:228-232.http://www.ncbi.nlm.nih.gov/pubmed/12861167?tool=bestpractice.com[4]Million M, Roblot F, Carles D, et al. Reevaluation of the risk of fetal death and malformation after Q fever. Clin Infect Dis. 2014;59:256-260.http://cid.oxfordjournals.org/content/59/2/256.longhttp://www.ncbi.nlm.nih.gov/pubmed/24748522?tool=bestpractice.com

流产

急性感染患者恢复后可表现出神经系统后遗症。

残留神经功能障碍可表现为无力、复发性脑膜刺激症、视力模糊、感觉异常及减退。

其他并发症包括行为改变、小脑症状体征、颅神经麻痹、锥体外系病变、MillerFisher综合征和变异性格林-巴利综合征。

肺炎康复后出现脱髓鞘性多发性周围神经病的病例已有报道。[1]Marrie TJ, Raoult D. Coxiella burnetii. In Mandell GL, Bennett JE, Dolin R, eds. Principles and practice of infectious diseases. 6th ed. Philadelphia, PA: Churchill Livingstone; 2005.