Q fever history and symptoms: Difference between revisions
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*[[Incubation period]] is usually 2 to 3 weeks. | *[[Incubation period]] is usually 2 to 3 weeks. | ||
===Acute Q fever | ===Acute Q fever=== | ||
====Flu like symptoms | ====Flu like symptoms==== | ||
The most common manifestation is flu-like symptoms with abrupt onset of: | The most common manifestation is flu-like symptoms with abrupt onset of: | ||
*[[Fever|High grade fever]]: Fever is usually accompanied by [[chills]] and sweats<ref name="pmid18452690">{{cite journal |vauthors=Hartzell JD, Wood-Morris RN, Martinez LJ, Trotta RF |title=Q fever: epidemiology, diagnosis, and treatment |journal=Mayo Clin. Proc. |volume=83 |issue=5 |pages=574–9 |year=2008 |pmid=18452690 |doi=10.4065/83.5.574 |url=}}</ref> | *[[Fever|High grade fever]]: Fever is usually accompanied by [[chills]] and sweats<ref name="pmid18452690">{{cite journal |vauthors=Hartzell JD, Wood-Morris RN, Martinez LJ, Trotta RF |title=Q fever: epidemiology, diagnosis, and treatment |journal=Mayo Clin. Proc. |volume=83 |issue=5 |pages=574–9 |year=2008 |pmid=18452690 |doi=10.4065/83.5.574 |url=}}</ref> | ||
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*[[Arthralgia|Arthralgias]] | *[[Arthralgia|Arthralgias]] | ||
====Pneumonia | ====Pneumonia==== | ||
Usually mild and accidentally discovered on [[X rays]] | Usually mild and accidentally discovered on [[X rays]] | ||
*If accompanied by [[a cough]], cough is dry and nonproductive.<ref name="pmid2731605">{{cite journal |vauthors=Sobradillo V, Ansola P, Baranda F, Corral C |title=Q fever pneumonia: a review of 164 community-acquired cases in the Basque country |journal=Eur. Respir. J. |volume=2 |issue=3 |pages=263–6 |year=1989 |pmid=2731605 |doi= |url=}}</ref> | *If accompanied by [[a cough]], cough is dry and nonproductive.<ref name="pmid2731605">{{cite journal |vauthors=Sobradillo V, Ansola P, Baranda F, Corral C |title=Q fever pneumonia: a review of 164 community-acquired cases in the Basque country |journal=Eur. Respir. J. |volume=2 |issue=3 |pages=263–6 |year=1989 |pmid=2731605 |doi= |url=}}</ref> | ||
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*Rarely progresses to [[Acute respiratory distress syndrome|acute respiratory distress syndrome (ARDS)]] which can be life threatening. | *Rarely progresses to [[Acute respiratory distress syndrome|acute respiratory distress syndrome (ARDS)]] which can be life threatening. | ||
====Hepatitis | ====Hepatitis==== | ||
*[[Right upper quadrant pain|Abdominal right upper quadrant pain]] | *[[Right upper quadrant pain|Abdominal right upper quadrant pain]] | ||
*[[Jaundice]] | *[[Jaundice]] | ||
*[[Gastrointestinal tract|GI]] symptoms as [[nausea]], [[malaise]], [[vomiting]], [[diarrhea]] and [[bloating]]. | *[[Gastrointestinal tract|GI]] symptoms as [[nausea]], [[malaise]], [[vomiting]], [[diarrhea]] and [[bloating]]. | ||
====Rare acute Q fever symptoms | ====Rare acute Q fever symptoms==== | ||
====Pericarditis and myocarditis | ====Pericarditis and myocarditis==== | ||
*[[Myocarditis]] is rare but carries a bad prognosis<ref name="pmid6622891">{{cite journal |vauthors=Derrick EH |title="Q" fever, a new fever entity: clinical features, diagnosis and laboratory investigation |journal=Rev. Infect. Dis. |volume=5 |issue=4 |pages=790–800 |year=1983 |pmid=6622891 |doi= |url=}}</ref> | *[[Myocarditis]] is rare but carries a bad prognosis<ref name="pmid6622891">{{cite journal |vauthors=Derrick EH |title="Q" fever, a new fever entity: clinical features, diagnosis and laboratory investigation |journal=Rev. Infect. Dis. |volume=5 |issue=4 |pages=790–800 |year=1983 |pmid=6622891 |doi= |url=}}</ref> | ||
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*[[Palpitation]] | *[[Palpitation]] | ||
====Neurologic findings | ====Neurologic findings==== | ||
*Q fever can present with [[meningoencephalitis]] | *Q fever can present with [[meningoencephalitis]] | ||
*[[Headache]] | *[[Headache]] | ||
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*[[Seizures]] | *[[Seizures]] | ||
====Dermatologic findings | ====Dermatologic findings==== | ||
*[[Maculopapular rash]] | *[[Maculopapular rash]] | ||
*[[Rash|Diffuse punctate rash]] | *[[Rash|Diffuse punctate rash]] | ||
*[[Erythema nodosum]] | *[[Erythema nodosum]] | ||
====Q fever during pregnancy | ====Q fever during pregnancy==== | ||
Most [[Coxiella burnetii|C. brutenii]] infection during pregnancy pass [[asymptomatic]] but in rare cases it can be complicated with: | Most [[Coxiella burnetii|C. brutenii]] infection during pregnancy pass [[asymptomatic]] but in rare cases it can be complicated with: | ||
*[[Intrauterine growth retardation|Intrauterine growth retardation (IUGR)]]<ref name="pmid9770161">{{cite journal |vauthors=Stein A, Raoult D |title=Q fever during pregnancy: a public health problem in southern France |journal=Clin. Infect. Dis. |volume=27 |issue=3 |pages=592–6 |year=1998 |pmid=9770161 |doi= |url=}}</ref> | *[[Intrauterine growth retardation|Intrauterine growth retardation (IUGR)]]<ref name="pmid9770161">{{cite journal |vauthors=Stein A, Raoult D |title=Q fever during pregnancy: a public health problem in southern France |journal=Clin. Infect. Dis. |volume=27 |issue=3 |pages=592–6 |year=1998 |pmid=9770161 |doi= |url=}}</ref> | ||
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Infection during [[first trimester]] and [[placental]] infection are associated with increased risk of fetal compromise. | Infection during [[first trimester]] and [[placental]] infection are associated with increased risk of fetal compromise. | ||
===Chronic Q fever | ===Chronic Q fever=== | ||
Chronic Q fever, characterized by [[infection]] that persists for more than 6 months is uncommon but is a much more serious disease. Patients who have had acute Q fever may develop the chronic form as soon as 1 year or as long as 20 years after initial infection.<ref name="pmid1489455">{{cite journal |vauthors=Choyce DP |title=Anterior chamber lens exchange |journal=J Cataract Refract Surg |volume=18 |issue=5 |pages=537 |year=1992 |pmid=1489455 |doi= |url=}}</ref> | Chronic Q fever, characterized by [[infection]] that persists for more than 6 months is uncommon but is a much more serious disease. Patients who have had acute Q fever may develop the chronic form as soon as 1 year or as long as 20 years after initial infection.<ref name="pmid1489455">{{cite journal |vauthors=Choyce DP |title=Anterior chamber lens exchange |journal=J Cataract Refract Surg |volume=18 |issue=5 |pages=537 |year=1992 |pmid=1489455 |doi= |url=}}</ref> | ||
====Endocarditis | ====Endocarditis==== | ||
[[Endocarditis]] is the main manifestation of Q fever. | [[Endocarditis]] is the main manifestation of Q fever. | ||
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**[[Embolic|Embolic manifestations]] | **[[Embolic|Embolic manifestations]] | ||
====Skeletal manifestations | ====Skeletal manifestations==== | ||
*[[Bone]] and [[joint]] infections are common manifestations of chronic Q fever. | *[[Bone]] and [[joint]] infections are common manifestations of chronic Q fever. | ||
*Presents with: | *Presents with: | ||
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**Bone and joint pain as in chronic [[osteomyelitis]] | **Bone and joint pain as in chronic [[osteomyelitis]] | ||
====Vascular lesions | ====Vascular lesions==== | ||
*Usually in previously affected vessel (e.g. [[aneurysm]]) | *Usually in previously affected vessel (e.g. [[aneurysm]]) | ||
====Cardiopulmonary affection | ====Cardiopulmonary affection==== | ||
*Chronic [[pleural]] or [[pericardial]] effusion and Interstitial [[pulmonary fibrosis]] present with [[dyspnea]] and [[fatigue]]. | *Chronic [[pleural]] or [[pericardial]] effusion and Interstitial [[pulmonary fibrosis]] present with [[dyspnea]] and [[fatigue]]. | ||
====Hepatic manifestations | ====Hepatic manifestations==== | ||
*[[Hepatic fibrosis|Liver fibrosis]] or [[cirrhosis]] presents with symptoms of chronic [[Hepatic failure|hepatic decompensation]] (e.g [[jaundice]], [[abdominal pain]], [[fatigue]], etc). | *[[Hepatic fibrosis|Liver fibrosis]] or [[cirrhosis]] presents with symptoms of chronic [[Hepatic failure|hepatic decompensation]] (e.g [[jaundice]], [[abdominal pain]], [[fatigue]], etc). | ||
====Chronic fatigue syndrome | ====Chronic fatigue syndrome==== | ||
*Presents in up to 10% of chronic Q fever patients. | *Presents in up to 10% of chronic Q fever patients. | ||
Revision as of 13:26, 31 July 2017
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Ahmed Younes M.B.B.CH [2]
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Overview
Acute Q fever presents with flu like symptoms, pneumonia and hepatitis. Chronic Q fever almost always presents with endocarditis and sometimes gives musculoskeletal and vascular manifestations.
History and symptoms
- Q fever can present with a wide variety of symptoms related to multiple organs involved. Q fever can be classified into acute and chronic based on the onset of symptoms.[1][2]
- Incubation period is usually 2 to 3 weeks.
Acute Q fever
Flu like symptoms
The most common manifestation is flu-like symptoms with abrupt onset of:
- High grade fever: Fever is usually accompanied by chills and sweats[3]
- Headaches: Retrobulbar and associated with photophobia
- Arthralgias
Pneumonia
Usually mild and accidentally discovered on X rays
- If accompanied by a cough, cough is dry and nonproductive.[4]
- Dyspnea
- Pleuritic chest pain
- Rarely progresses to acute respiratory distress syndrome (ARDS) which can be life threatening.
Hepatitis
- Abdominal right upper quadrant pain
- Jaundice
- GI symptoms as nausea, malaise, vomiting, diarrhea and bloating.
Rare acute Q fever symptoms
Pericarditis and myocarditis
- Myocarditis is rare but carries a bad prognosis[5]
- Chest pain
- Dyspnea
- Palpitation
Neurologic findings
- Q fever can present with meningoencephalitis
- Headache
- Confusion
- Seizures
Dermatologic findings
Q fever during pregnancy
Most C. brutenii infection during pregnancy pass asymptomatic but in rare cases it can be complicated with:
- Intrauterine growth retardation (IUGR)[6]
- Intrauterine fetal death (IUFD)
- Abortion
Infection during first trimester and placental infection are associated with increased risk of fetal compromise.
Chronic Q fever
Chronic Q fever, characterized by infection that persists for more than 6 months is uncommon but is a much more serious disease. Patients who have had acute Q fever may develop the chronic form as soon as 1 year or as long as 20 years after initial infection.[2]
Endocarditis
Endocarditis is the main manifestation of Q fever.
- Characterized by being culture negative endocarditis
- Patients who are predisposed to endocarditis include patients with valvular lesions, prosthetic valves and immunocompromised patients
- Presents with:
Skeletal manifestations
- Bone and joint infections are common manifestations of chronic Q fever.
- Presents with:
- Low grade fever
- Bone and joint pain as in chronic osteomyelitis
Vascular lesions
- Usually in previously affected vessel (e.g. aneurysm)
Cardiopulmonary affection
- Chronic pleural or pericardial effusion and Interstitial pulmonary fibrosis present with dyspnea and fatigue.
Hepatic manifestations
- Liver fibrosis or cirrhosis presents with symptoms of chronic hepatic decompensation (e.g jaundice, abdominal pain, fatigue, etc).
Chronic fatigue syndrome
- Presents in up to 10% of chronic Q fever patients.
References
- ↑ Ishikawa H, Maeda H, Takamatsu H, Saito Y (1979). "Systemic hyalinosis (juvenile hyaline fibromatosis). Ultrastructure of the hyaline with particular reference to the cross-banded structure". Arch. Dermatol. Res. 265 (2): 195–206. PMID 88923.
- ↑ 2.0 2.1 Choyce DP (1992). "Anterior chamber lens exchange". J Cataract Refract Surg. 18 (5): 537. PMID 1489455.
- ↑ Hartzell JD, Wood-Morris RN, Martinez LJ, Trotta RF (2008). "Q fever: epidemiology, diagnosis, and treatment". Mayo Clin. Proc. 83 (5): 574–9. doi:10.4065/83.5.574. PMID 18452690.
- ↑ Sobradillo V, Ansola P, Baranda F, Corral C (1989). "Q fever pneumonia: a review of 164 community-acquired cases in the Basque country". Eur. Respir. J. 2 (3): 263–6. PMID 2731605.
- ↑ Derrick EH (1983). ""Q" fever, a new fever entity: clinical features, diagnosis and laboratory investigation". Rev. Infect. Dis. 5 (4): 790–800. PMID 6622891.
- ↑ Stein A, Raoult D (1998). "Q fever during pregnancy: a public health problem in southern France". Clin. Infect. Dis. 27 (3): 592–6. PMID 9770161.