Fevers Q fever

Ticks have a bad reputation for good reasons. Not only are they carriers of a number of diseases, the saliva of some can cause paralysis. North American natives were aware of tick paralysis, but the condition was officially noted as a disease of both animals and humans in 1912. The bites of at least 60 species of ticks can cause paralysis, which often does not appear until several days after the bite. The first indication is redness and swelling around the site of the bite. This is followed by neuromuscular weakness and difficulty in walking. If the tick is not removed, speech and breathing are affected, with eventual respiratory paralysis and death. Fortunately, removal of the tick results in a quick recovery of function. The exact mechanism of paralysis is not known but it appears to come from a substance that affects the neuromuscular junction. While not related to the venom of the tick saliva, the tick can also transmit diseases such as Lyme disease, Rocky Mountain spotted fever, Q fever, typhus, and others. Table 13.1 lists some venomous arachnids. 

Chloramphenicol is prescribed to treat meningitis (//. influenzae, S. pneumoniae, and N. meningitides), parathyroid fever, Q fever, Rocky Mountain spotted fever, typhoid fever, typhus infections, brain abscesses, and bacterial septicemia. 

Crimean-Congo Hemorrhagic Fever Dengue (DF, DHF, DSS) Mediterranean Spotted Fever Q Fever... 

Later many other diseases would be developed for use as weapons, including plague, Rocky Mountain spotted fever, Rift Valley fever, Q fever and various forms of encephalomyelitis. But in 1950 these four looked the most promising potential germ weapons. During the next two decades over seven hundred million dollars would be spent on the development of such weapons in the United States, and hundreds of millions more in research and testing projects in America, Britain and Canada. 

Rickettsia—Rocky Mountain spotted fever, endemic typhus (murine), epidemic typhus (louse-borne), scrub typhus, (Orientia tsutsugamushi), trench fever, Q fever... 

Q fever BJckettsiae bumeti, also caHed Coxiella bumeti spread by ticks and inhalation... 

Amongst the diseases caused by rickettsiae are epidemic typhus, trench fever and murine typhus, caused by R. prowozefa) R. quintana a.nA R. typhi, respectively. Q-fever is caused by Coxiella burned. 

Streptococcus pneumoniae remains the commonest cause of pneumonia and responds well to penicillin. In addition, a number of atypical infections may cause pneumonia and include Mycoplasma pneumoniae, Legionella pneumophila, psittacosis and occasionally Q fever. With psittacosis there may be a history of contact with parrots or budgerigars while Legionnaires disease has often been acquired during hotel holidays... 

Infliximab (Remicade) 3-1 0 mg/kg at 0, 2, and 6 weeks then q 8 weeks IV infusion 1 -4 weeks IR (rash, urticaria, flushing, HA, fever, chills, nausea, tachycardia, dyspnea) Monitor for infection Screen for tuberculosis... 

Suggested Alternatives for Differential Diagnosis Brucellosis, chlamydial pneumonias, infective endocarditis, legionnaires disease, mycoplasma infections, pneumonia, Cox-iella burnetii infection, Francisella tularensis infection, Q fever, tuberculosis, tularemia, typhoid fever, and all atypical pneumonia. 

Suggested Alternatives for Differential Diagnosis Psittacosis, Q fever, plague, diphtheria, tick-borne diseases, mycotic infections. 

Suggested Alternatives for Differential Diagnosis Bronchitis, pneumonia, meningitis, gastroenteritis, septic shock, congestive heart failure and pulmonary edema, pleural effusion, costochondritis, prostatitis, adult respiratory distress syndrome (ARDS), HIV infection and AIDS, and Q fever. 

Suggested Alternatives for Differential Diagnosis Dengue, measles, Rocky Mountain spotted fever, rubella, tick bite fever, epidemic typhus, Q fever, typhoid, malaria, trypanosomiasis, hepatitis, infectious mononucleosis, herpes, and influenza. 

Suggested Alternatives for Differential Diagnosis Drug induced noncardiac pulmonary edema, acute respiratory distress syndrome, pneumonic plague, tularemia, Q fever, and viral influenza. 

Most often consideration is given only to keeping odors from reaching other parts of the building. From a health and safety perspective, this is the last of many reasons for the use of a separate ventilation system. In some research applications the animals in use or the diseases under study are zoonotic (animal diseases transferable to humans). Under these conditions special precautions must be taken to prevent exposure to humans. For example, sheep carry a zoonotic disease called Q Fever which is... 

Category B agents There are eleven Category B agents as follows brucellosis, epsilon toxin (clostridium perfringens), glanders, melioidosis, psittacosis, Q fever, ricin toxin, staphylococcus enterotoxin B, typhus fever, viral encephalitis, and water safety threats. 

Guides for Emergency Response Biological Agent or Weapon Q Fever... 

Diagnosis Q fever is not a clinically distinct illness and may resemble a viral illness or other types of atypical pneumonia. The diagnosis is confirmed serologically. As for treatment, Q fever is generally a self-limiting illness even without treatment. Tetracycline or doxycycline are the treatments of choice and are given orally for five to seven days. Q fever endocarditus, which is rare, is much more difficult to treat. 

Differential Diagnosis Q fever usually presents as an undifferentiated febrile illness, or a primary atypical pneumonia, which must be differentiated from pneumonia caused by mycoplasm, Tegionnaires disease, psittacosis or Chlamydia pneumoniae. More rapidly progressive forms of pneumonia may look like bacterial pneumonia including tularemia or plague. 

Duration of Illness Two days to three weeks. A high fever could persist for three weeks or more, but treatment with antibiotics is usually effective within thirty-six to forty-eight hours. With treatment or without treatment, Q fever is generally a self-limiting illness. 

Symptoms Symptoms appear about ten to twenty days after the Q fever rickettsia are inhaled. The symptoms resemble flu symptoms and include fever, chills, headache, fatigue and muscle aches. About one half of persons with symptoms will have pneumonia evident on chest X-ray and some of these will have a cough or chest pain. The complications of meningitis or and inflammation of the heart may arise, but these are uncommon. Normally, the duration of Q fever is two days to two weeks at which time the disease resolves without permanent effects on the individual. 

Characteristics As a natural disease Q fever, a rickettsial illness caused by Coxiella burnetii, is typically spread by inadvertent aerosolisation of organisms from infected animal... 

Field First Aid In a terrorist attack with Q fever, the primary threat is dissemination of aerosol, or contamination of food. Acute Q fever can appear to develop as an undifferentiated febrile illness, as an atypical pneumonia, or as a rapidly progressive pneumonia. 

Acute Q fever Administer doxycycline 100 mg orally every twelvehours for five days after victim is afebrile (free of fever). Administer tetracycline 500 mg every six hours for five days after the victim is afebrile. If a victim appears unable to take tetracycline, try ciprofloxacin and other quinolones, which are active in vitro the duration of the therapy is usually five to seven days, at least two days after the victim is afebrile. 

Regarding isolation and decontamination, Standard Precautions are recommended for healthcare personnel. Person-to-person transmission is rare. Victims exposed to Q fever by aerosol do not present a risk for secondary contamination or re-aerosolization of the organism. Decontamination can be done with soap and water, or a 0.5 percent chlorine solution on personnel. 

Q fever endocarditis, and other firms of chronic Q fever (which is very rare) is much more difficult to treat. Such treatment is very complex, even controversial, and beyond the scope of this volume. 

Medical Management Standard Precautions are recommended for healthcare personnel. Most cases of acute Q fever will eventually resolve without antibiotic treatment, but all suspected cases of Q fever should be treated to reduce the risk of complications. 

Tetracycline 500 mg every six hours or doxycycline 100 mg every twelve hours for five to seven days will shorten the duration of illness, and fever usually disappears within one to two days after treatment is begun. Ciprofloxacin and other quinolones are active in vitro and should be considered for victims unable to take tetracycline or doxycycline. Successful treatment of Q fever endocarditis is much more difficult. Tetracycline or doxycycline given in combination with trimethoprim-sulfamethoxazole (TMP-SMX) or rifampin for twelve months or longer has been successful in some cases. However, valve replacement is often required to achieve a cure. 

Symptoms Q fever typically presents as an undifferentiated illness, with fever, chills, cough, headache, weakness, and chest pain occurring as early as ten days after exposure. Onset may be sudden or insidious. Pneumonia is present in some cases, but pulmonary syndromes are usually not prominent. Victims are not generally critically ill, and the illness last from two days to two weeks. Complications include hepatitis and a peculiar form of chronic endocarditus that may be largely responsible for the few fatal cases that occur. 

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