Q fever - early

Definition

Q fever is an infectious disease that is spread by domestic and wild animals and ticks.

Causes, incidence, and risk factors

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.

People get Q fever after exposure to raw (unpasteurized) milk, or after inhaling dust or droplets in the air which are contaminated with animal feces, blood, or birth products.

Symptoms usually develop 2 to 3 weeks after coming in contact with the bacteria. This is called the incubation period. Some people may have no symptoms; others may have moderately severe symptoms similar to the flu. If symptoms occur, they may last for several weeks.

People at risk for infection include slaughterhouse workers, veterinarians, researchers, food processors, and sheep and cattle workers. Men are infected more often than women, and most people who get Q fever are between 30 and 70 years old.

This disease is occasionally seen in children, especially those who live on a farm. In infected children younger than 3 years old, Q fever is usually discovered during a search for the cause of pneumonia.

Symptoms

Common symptoms include:

• Dry cough (non-productive)
• Fever
• Headache
• Joint pain (arthralgia)
• Muscle pains

• Abdominal pain
• Chest pain
• Jaundice
• Rash

Signs and tests

A physical examination may reveal crackles in the lungs and an enlarged liver and spleen. In addition:

• A chest x-ray often shows pneumonia or other changes
• Antibodies for Coxiella are sometimes found in the blood
• Liver function test results may be higher than normal
• Low blood counts can develop
• Special stains may be done on infected tissues to identify the bacteria
• Tests may be performed to determine if the disease has affected the heart

Treatment

Treatment with antibiotics can shorten the length of the illness. Antibiotics that are commonly used include tetracycline and doxycycline. Tetracycline given by mouth should not be used by children who still have any baby teeth, because it can permanently discolor growing teeth.

Expectations (prognosis)

You will get better even without treatment. However, complications can be very serious and sometimes even life-threatening. Q fever should always be treated if it is recognized as the cause of symptoms.

Complications

• Bone infection (osteomyelitis )
• Brain infection (encephalitis)
• Heart valve infection (endocarditis )
• Infection returns
• Liver infection (chronic hepatitis)
• Lung infection (pneumonia )

Calling your health care provider

Call your health care provider if you develop symptoms of Q fever. Also call if you have been treated for Q fever and symptoms return or new symptoms develop.

Prevention

Pasteurization of milk destroys the bacteria that cause early Q fever. Domestic animals should be inspected for signs of Q fever if people exposed to them have developed symptoms of the disease.

References

Marrie TJ, Raoult D. Coxiella burnetii (Q fever). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 6th ed. Philadelphia, Pa: Churchill Livingstone Elsevier; 2005: chap 186.

Raoult D. Rickettsioses. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 348.