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Revision as of 15:51, 26 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]

Q fever Microchapters

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Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Q fever from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications, and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Chest X Ray

CT

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary prevention

Secondary prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

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Overview

Q fever is caused by infection with Coxiella burnetii. This organism is uncommon but may be found in cattle, sheep, goats and other domestic mammals, including cats and dogs. The infection results from inhalation of contaminated particles in the air, and from contact with the vaginal mucus, milk, feces, urine or semen of infected animals. The incubation time is 9-40 days. It is considered possibly the most infectious disease in the world, as a human being can be infected by a single bacterium [1].

Historical prespective

The disease was first described by Edward Holbrook Derrick in Australia while the pathogen was first described in 1937 by Frank Macfarlane Burnet.

Classification

According to the onset of symptoms, Q fever can be classified into acute and chronic.

Pathophysiology

Q fever is a disease caused by C. brutenii, an intracellular gram-negative proteobacterium. The disease can have a wide range of clinical presentations and affect many organ systems due to the unique virulence factors of the organism.

Causes

Q fever is caused by the bacteria Coxiella burnetii, which lives in domestic animals such as cattle, sheep, goats, birds, and cats. Some wild animals and ticks also carry the bacteria. Q fever may be contracted through drinking raw (unpasteurized) milk, or after inhaling dust or droplets in the air that are contaminated with animal feces, blood, or birth products.

Differential diagnosis

Q fever must be differentiated from other diseases that cause atypical pneumonia such as mycoplasma pneumonia and legionella pneumonia.

Epidemiology and demographics

C.brutenii is found everywhere except Antarctica and New Zealand.The disease is slightly more prevalent in elder people and in males.

Risk factors

The organism is present mainly in the secretions of cattle and sheep. Any occupation that involves contact with cattle and sheep increases the risk of the disease.

Natural history, complications, and prognosis

Acute Q fever has a good prognosis even without treatment. Chronic Q fever has a less favorable prognosis.

History and symptoms

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.

Physical examination

Patients with Q fever usually appear ill. Physical examination of patients with Q fever is usually remarkable for fever, pneumonia, and hepatomegaly.

Laboratory Findings

Laboratory findings consistent with the diagnosis of Q fever include positive serology for antibodies (especially Indirect immunofluorescence (IIF), positive PCR, and elevated liver enzymes.

Chest X Ray

On chest X-ray, Q fever is characterized by either signs of atypical pneumonia (hazy nonlocalized airspace opacities) or it may show signs of typical pneumonia (lobar consolidation and occasional pleural effusions) in few patients.

CT

Chest CT scan may be helpful in the diagnosis of Q fever. Findings on CT scan suggestive of Q fever include scattered consolidation and opacities or lobar consolidation in one specific lobe.

MRI

There are no additional MRI findings associated with Q fever. Chest X-ray and CT are usually sufficient to diagnose Q fever.

Other imaging findings

There are no other specific imaging findings for Q fever.

Other diagnostic studies

There are no additional diagnostic findings for Q fever.

Medical Therapy

The mainstay of therapy for Q fever is doxycycline. The chronic form is more difficult to treat and can require up to two years of treatment with doxycycline and Hydroxychloroquine. Q fever in pregnancy is especially difficult to treat because doxycycline is contraindicated in pregnancy and so preferred treatment is Trimethoprim/Sulfamethoxazole.

Surgery

Surgical intervention is not recommended for the management of Q fever.

Primary prevention

Effective measures for the primary prevention of Q fever include educating the public on sources of infection, appropriate disposal of the placenta, birth products, fetal membranes, and aborted fetuses at facilities housing sheep and goats and restricting access to barns and laboratories used in housing potentially infected animals.

Secondary prevention

There are no secondary preventive measures available for Q fever.

References


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