A 9-year-old boy presenting with headache and fever, followed after 10 days by drowsiness, conjugate ocular deviation, and subsequently, cerebellar ataxia, is reported from Akita University, Japan. CSF showed pleocytosis, increased protein, and isolation of C. burnetii during convalescence. MRI showed a herniated tonsil and swollen vermis of the cerebellum. Recovery followed treatment with minocycline. A cow-raising family lived in the neighborhood. [1]

COMMENT. Coxiella burnetii is the causative rickettsial organism in acute Q. fever. The illness is usually manifested by a self-limited flu-like illness, a mild-tomoderate atypical pneumonia, and hepatosplenomegaly. Endocarditis and hepatitis are the major manifestations of chronic disease. Headache occurs in the majority of patients in acute stages, but cerebellitis has not previously been reported. Human disease is uncommon, but animal infection, primarily domestic farm animals, is widespread and usually asymptomatic. Consumption of raw milk and close contact with infected animals are risk factors. Incubation is usually 14 to 22 days. Tetracycline or doxycycline is the drug of choice. (American Academy of Pediatrics, 1997 Red Book, pp433-435)