Coxiella burnetii is a facultative intracellular coccobacillus. Intracellular survival in which cell type is important for Q fever pathogenesis?

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Coxiella burnetii relies on replicating inside macrophages, specifically within the acidic phagolysosome that forms after the macrophage engulfs the bacteria. This intracellular niche lets the organism survive, multiply, and hitch a ride in circulating monocytes to disseminate to the reticuloendothelial system, including liver and spleen, driving Q fever disease. Neutrophils typically kill bacteria quickly and aren’t the pathogen’s replication site; epithelial cells and lymphocytes are not the main intracellular niche for Coxiella. Therefore, surviving and replicating in monocytes/macrophages is central to its pathogenesis.