Q fever

Q fever is a zoonotic disease caused by Coxiella burnetii, a species of bacteria that is distributed globally. In 1999, Q fever became a notifiable disease in the United States but reporting is not required in many other countries. Because the disease is underreported, scientists cannot reliably assess how many cases of Q fever have actually occurred worldwide. Many human infections are inapparent. 

Ingestion of contaminated milk, followed by regurgitation and inspiration of the contaminated food, is a less common mode of transmission. Other modes of transmission to humans, including lick bites and human to human transmission, are rare. 

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 I year or as long as 20 years after initial infection. A serious complication of clironic Q fever is endocarditis, generally involving the aortic heart valves, less commonly the 

The incubation period for Q fever varies depending on the number of organisms that initially infect the patient. Infection with greater numbers of organisms will result in shorter incubation periods. Most patients become ill within 2-3 weeks after exposure. Those who recover fully from infection may possess lifelong immunity agaittst re-infection. 

Recent studies have shown that greater accuracy in the diagnosis of Q fever can be achieved by looking at specific levels of classes of antibodies other than IgG, namely IgA and IgM. Combined detection of IgM and IgA in addition to IgG improves the. specificity of the assays and provides better accuracy in diagnosis. IgM levels are helpful in the determination of a recent infection. In acute Q fever, patients will have IgG antibodies to phase II and IgM antibodies to phases I and II. Increased IgG and IgA antibodies to phase I are often indicative of Q fever endocarditis. 

Clinical Disease in Domestic Animals Clinical Disease in Humans Diagnosis 

Colonel, Medical Corps, U.S. Army Chief, Genetics and Physiology Branch, Bacteriology Division, U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, Maryland 21702-5011 

Since the disease was described in 1937, thousands of cases involving military personnel of many countries have been reported (an excellent review was published in 1978 ), and infection with C burnetii should be considered a possibility whenever troops are present in an area with infected animals. 

Hundreds of cases consistent with Q fever were observed in German soldiers in Serbia and southern Yugoslavia during World War II. Outbreaks occurred in the apparent absence of disease in the indigenous population. The disease was most commonly referred to as Balkengrippe infection with C burnetii was not confirmed by laboratory testing, but the clinical and epidemiological features of the illness described were most consistent with Q fe- 

The primary reservoir for natural human infection is livestock, particularly parturient females, and the distribution is worldwide. Outbreaks of Q fever are infrequently reported, however, and the disease may be endemic in areas where cases are rarely or never reported. Humans who work in animal husbandry, especially those who assist during parturition (eg, calving or lambing) are at risk for acquiring Q fever. However, a definite risk also exists for persons who live in close proximity to, or who pass through, an area where animal birthing is occurring, even if this occurred months previously. 

Infected dust and other materials from many animals, including sheep, cattle, goats, rodents, ticks [15] 

Bowel movements - diarrhea Chest - crackles (rales) 

Chest - friction rub Chest - pain, pleuritic Chills 

nonproductive Eyes, retroorbital - pain Eyes, vision - double (diplopia) 

Liver - large (hepatomegaly) Mentation - hallucinations [3] Mentation - weak (malaise) 

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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... 

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. 

Q-Fever 1. Aerosol 2. Sabotage (food supply) No High 1-20 days 2 days to 2 weeks Very low Stable Yes Effective No... 

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