Q fever

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Q fever
Immunohistochemical detection of Coxiella burnetii in resected cardiac valve of a 60-year-old man with Q fever endocarditis.jpg
Immunohistochemical detection of C. burnetii in resected cardiac valve of a 60-year-old man with Q fever endocarditis, Cayenne, French Guiana: Monoclonal antibodies against C. burnetii and hematoxylin were used for staining; original magnification is ×50.
Specialty Infectious disease   Blue pencil.svg

Q fever is a disease caused by infection with Coxiella burnetii , [1] [2] a bacterium that affects humans and other animals. 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 a spore-like small-cell variant, and from contact with the milk, urine, feces, vaginal mucus, or semen of infected animals. Rarely, the disease is tick-borne. [3] The incubation period is 9–40 days. Humans are vulnerable to Q fever, and infection can result from even a few organisms. [3] The bacterium is an obligate intracellular pathogenic parasite.

<i>Coxiella burnetii</i> species of bacterium

Coxiella burnetii is an obligate intracellular bacterial pathogen, and is the causative agent of Q fever. The genus Coxiella is morphologically similar to Rickettsia, but with a variety of genetic and physiological differences. C. burnetii is a small Gram-negative, coccobacillary bacterium that is highly resistant to environmental stresses such as high temperature, osmotic pressure, and ultraviolet light. These characteristics are attributed to a small cell variant form of the organism that is part of a biphasic developmental cycle, including a more metabolically and replicatively active large cell variant form. It can survive standard disinfectants, and is resistant to many other environmental changes like those presented in the phagolysosome.

Cattle domesticated form of Aurochs

Cattle—colloquially cows—are the most common type of large domesticated ungulates. They are a prominent modern member of the subfamily Bovinae, are the most widespread species of the genus Bos, and are most commonly classified collectively as Bos taurus.

Sheep Domesticated ruminant bred for meat, wool and milk

Domestic sheep are quadrupedal, ruminant mammals typically kept as livestock. Like most ruminants, sheep are members of the order Artiodactyla, the even-toed ungulates. Although the name sheep applies to many species in the genus Ovis, in everyday usage it almost always refers to Ovis aries. Numbering a little over one billion, domestic sheep are also the most numerous species of sheep. An adult female sheep is referred to as a ewe, an intact male as a ram or occasionally a tup, a castrated male as a wether, and a younger sheep as a lamb.


Signs and symptoms

Incubation period is usually two to three weeks. [4] The most common manifestation is flu-like symptoms with abrupt onset of fever, malaise, profuse perspiration, severe headache, muscle pain, joint pain, loss of appetite, upper respiratory problems, dry cough, pleuritic pain, chills, confusion, and gastrointestinal symptoms, such as nausea, vomiting, and diarrhea. About half of infected individuals exhibit no symptoms. [4]

Fever common medical sign characterized by elevated body temperature

Fever, also known as pyrexia and febrile response, is defined as having a temperature above the normal range due to an increase in the body's temperature set point. There is not a single agreed-upon upper limit for normal temperature with sources using values between 37.5 and 38.3 °C. The increase in set point triggers increased muscle contractions and causes a feeling of cold. This results in greater heat production and efforts to conserve heat. When the set point temperature returns to normal, a person feels hot, becomes flushed, and may begin to sweat. Rarely a fever may trigger a febrile seizure. This is more common in young children. Fevers do not typically go higher than 41 to 42 °C.

Malaise is a feeling of general discomfort, uneasiness or pain, often the first sign of an infection or other disease. The word has existed in the French language since at least the 12th century.

Headache pain in the head or neck

Headache is the symptom of pain anywhere in the region of the head or neck. It occurs in migraines, tension-type headaches, and cluster headaches. Frequent headaches can affect relationships and employment. There is also an increased risk of depression in those with severe headaches.

During its course, the disease can progress to an atypical pneumonia, which can result in a life-threatening acute respiratory distress syndrome, whereby such symptoms usually occur during the first four to five days of infection.[ citation needed ]

Atypical pneumonia, also known as walking pneumonia, is the type of pneumonia not caused by one of the pathogens most commonly associated with the disease. Its clinical presentation contrasts to that of "typical" pneumonia. A variety of microorganisms can cause it. When it develops independently from another disease it is called primary atypical pneumonia (PAP).

Acute respiratory distress syndrome Human disease

Acute respiratory distress syndrome (ARDS) is a type of respiratory failure characterized by rapid onset of widespread inflammation in the lungs. Symptoms include shortness of breath, rapid breathing, and bluish skin coloration. Among those who survive, a decreased quality of life is relatively common.

Less often, Q fever causes (granulomatous) hepatitis, which may be asymptomatic or becomes symptomatic with malaise, fever, liver enlargement, and pain in the right upper quadrant of the abdomen. Whereas transaminase values are often elevated, jaundice is uncommon. Retinal vasculitis is a rare manifestation of Q fever. [5]

Hepatitis inflammation of the liver tissue

Hepatitis is inflammation of the liver tissue. Some people have no symptoms whereas others develop yellow discoloration of the skin and whites of the eyes, poor appetite, vomiting, tiredness, abdominal pain, or diarrhea. Hepatitis may be temporary (acute) or long term (chronic) depending on whether it lasts for less than or more than six months. Acute hepatitis can sometimes resolve on its own, progress to chronic hepatitis, or rarely result in acute liver failure. Over time the chronic form may progress to scarring of the liver, liver failure, or liver cancer.

Hepatomegaly symptom

Hepatomegaly is the condition of having an enlarged liver. It is a non-specific medical sign having many causes, which can broadly be broken down into infection, hepatic tumours, or metabolic disorder. Often, hepatomegaly will present as an abdominal mass. Depending on the cause, it may sometimes present along with jaundice.

Abdomen frontal part of the body between the thorax (chest) and pelvis

The abdomen constitutes the part of the body between the thorax (chest) and pelvis, in humans and in other vertebrates. The abdomen is the frontal part of the abdominal segment of the trunk, the dorsal part of this segment being the back of the abdomen. The region occupied by the abdomen is termed the abdominal cavity. In arthropods it is the posterior tagma of the body; it follows the thorax or cephalothorax. The abdomen stretches from the thorax at the thoracic diaphragm to the pelvis at the pelvic brim. The pelvic brim stretches from the lumbosacral joint to the pubic symphysis and is the edge of the pelvic inlet. The space above this inlet and under the thoracic diaphragm is termed the abdominal cavity. The boundary of the abdominal cavity is the abdominal wall in the front and the peritoneal surface at the rear.

The chronic form of Q fever is virtually identical to inflammation of the inner lining of the heart (endocarditis), [6] which can occur months or decades following the infection. It is usually fatal if untreated. However, with appropriate treatment, the mortality falls to around 10%.

Inflammation signs of activation of the immune system

Inflammation is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants, and is a protective response involving immune cells, blood vessels, and molecular mediators. The function of inflammation is to eliminate the initial cause of cell injury, clear out necrotic cells and tissues damaged from the original insult and the inflammatory process, and initiate tissue repair.

Endocarditis endocardium disease characterized by inflammation of the endocardium of the heart chambers and valves

Endocarditis is an inflammation of the inner layer of the heart, the endocardium. It usually involves the heart valves. Other structures that may be involved include the interventricular septum, the chordae tendineae, the mural endocardium, or the surfaces of intracardiac devices. Endocarditis is characterized by lesions, known as vegetations, which is a mass of platelets, fibrin, microcolonies of microorganisms, and scant inflammatory cells. In the subacute form of infective endocarditis, the vegetation may also include a center of granulomatous tissue, which may fibrose or calcify.


Q fever management algorithm from the Centers for Disease Control and Prevention Q fever management algorithm.gif
Q fever management algorithm from the Centers for Disease Control and Prevention

Diagnosis is usually based on serology [7] [8] (looking for an antibody response) rather than looking for the organism itself. Serology allows the detection of chronic infection by the appearance of high levels of the antibody against the virulent form of the bacterium. Molecular detection of bacterial DNA is increasingly used. Culture is technically difficult and not routinely available in most microbiology laboratories.

Serology is the scientific study of serum and other bodily fluids. In practice, the term usually refers to the diagnostic identification of antibodies in the serum. Such antibodies are typically formed in response to an infection, against other foreign proteins, or to one's own proteins.

Antibody large Y-shaped protein produced by B-cells, used by the immune system; large, Y-shaped protein produced mainly by plasma cells that is used by the immune system to neutralize pathogens such as pathogenic bacteria and viruses

An antibody (Ab), also known as an immunoglobulin (Ig), is a large, Y-shaped protein produced mainly by plasma cells that is used by the immune system to neutralize pathogens such as pathogenic bacteria and viruses. The antibody recognizes a unique molecule of the pathogen, called an antigen, via the Fab's variable region. Each tip of the "Y" of an antibody contains a paratope that is specific for one particular epitope on an antigen, allowing these two structures to bind together with precision. Using this binding mechanism, an antibody can tag a microbe or an infected cell for attack by other parts of the immune system, or can neutralize its target directly. Depending on the antigen, the binding may impede the biological process causing the disease or may activate macrophages to destroy the foreign substance. The ability of an antibody to communicate with the other components of the immune system is mediated via its Fc region, which contains a conserved glycosylation site involved in these interactions. The production of antibodies is the main function of the humoral immune system.

Q fever can cause endocarditis (infection of the heart valves) which may require transoesophageal echocardiography to diagnose. Q fever hepatitis manifests as an elevation of alanine transaminase and aspartate transaminase, but a definitive diagnosis is only possible on liver biopsy, which shows the characteristic fibrin ring granulomas. [9]


Protection is offered by Q-Vax, a whole-cell, inactivated vaccine developed by an Australian vaccine manufacturing company, CSL Limited. [10] The intradermal vaccination is composed of killed C. burnetii organisms. Skin and blood tests should be done before vaccination to identify pre-existing immunity, because vaccinating people who already have an immunity can result in a severe local reaction. After a single dose of vaccine, protective immunity lasts for many years. Revaccination is not generally required. Annual screening is typically recommended. [11]

In 2001, Australia introduced a national Q fever vaccination program for people working in “at risk” occupations. Vaccinated or previously exposed people may have their status recorded on the Australian Q Fever Register, [12] which may be a condition of employment in the meat processing industry. An earlier killed vaccine had been developed in the Soviet Union, but its side effects prevented its licensing abroad.

Preliminary results suggest vaccination of animals may be a method of control. Published trials proved that use of a registered phase  vaccine (Coxevac) on infected farms is a tool of major interest to manage or prevent early or late abortion, repeat breeding, anoestrus, silent oestrus, metritis, and decreases in milk yield when C. burnetii is the major cause of these problems. [13] [14]


Treatment of acute Q fever with antibiotics is very effective[ citation needed ] and should be given in consultation with an infectious diseases specialist.[ citation needed ] Commonly used antibiotics include doxycycline, tetracycline, chloramphenicol, ciprofloxacin, ofloxacin, and hydroxychloroquine. Chronic Q fever is more difficult to treat and can require up to four years of treatment with doxycycline and quinolones or doxycycline with hydroxychloroquine.

Q fever in pregnancy is especially difficult to treat because doxycycline and ciprofloxacin are contraindicated in pregnancy. The preferred treatment is five weeks of co-trimoxazole. [15]


C. burnetii, the Q fever-causing agent Coxiella burnetii 01.JPG
C. burnetii, the Q fever-causing agent

The pathogenic agent is found everywhere except New Zealand. [16] The bacterium is extremely sustainable and virulent: a single organism is able to cause an infection. The common source of infection is inhalation of contaminated dust, contact with contaminated milk, meat, or wool, and particularly birthing products. Ticks can transfer the pathogenic agent to other animals. Transfer between humans seems extremely rare and has so far been described in very few cases.

Some studies have shown more men to be affected than women, [17] [18] which may be attributed to different employment rates in typical professions.

“At risk” occupations include: [19]


Image A: A normal chest X-ray Image B: Q fever pneumonia Pneumonia x-ray.jpg
Image A: A normal chest X-ray Image B: Q fever pneumonia

Q fever was first described in 1935 by Edward Holbrook Derrick [20] in slaughterhouse workers in Brisbane, Queensland. The "Q" stands for "query" and was applied at a time when the causative agent was unknown; it was chosen over suggestions of abattoir fever and Queensland rickettsial fever, to avoid directing negative connotations at either the cattle industry or the state of Queensland. [21]

The pathogen of Q fever was discovered in 1937, when Frank Macfarlane Burnet and Mavis Freeman isolated the bacterium from one of Derrick’s patients. [22] It was originally identified as a species of Rickettsia . H.R. Cox and Gordon Davis elucidated the transmission when they isolated it from ticks found in the US state of Montana in 1938. [23] It is a zoonotic disease whose most common animal reservoirs are cattle, sheep, and goats. Coxiella burnetii – named for Cox and Burnet – is no longer regarded as closely related to the Rickettsiae, but as similar to Legionella and Francisella , and is a proteobacterium.

Society and culture

An early mention of Q fever was important in one of the early Dr. Kildare films (1939, Calling Dr. Kildare ). Kildare's mentor Dr. Gillespie (Lionel Barrymore) tires of his protégé working fruitlessly on "exotic diagnoses" ("I think it's Q fever!") and sends him to work in a neighborhood clinic, instead. [24] [25]

Q fever was also highlighted in an episode of the U.S. television medical drama House ("The Dig", season seven, episode 18).

Biological warfare

C  burnetii has been developed as a biological weapon. [26] The United States investigated it as a potential biological warfare agent in the 1950s, with eventual standardization as agent OU. At Fort Detrick and Dugway Proving Ground, human trials were conducted on Whitecoat volunteers to determine the median infective dose (18 MICLD50/person i.h.) and course of infection. The Deseret Test Center dispensed biological Agent OU with ships and aircraft, during Project 112 and Project SHAD. [27] As a standardized biological, it was manufactured in large quantities at Pine Bluff Arsenal, with 5,098 gallons in the arsenal in bulk at the time of demilitarization in 1970. C. burnetii is currently ranked as a "category B" bioterrorism agent by the CDC. [28] It can be contagious, and is very stable in aerosols in a wide range of temperatures. Q fever microorganisms may survive on surfaces up to 60 days. It is considered a good agent in part because its ID50 (number of bacilli needed to infect 50% of individuals) is considered to be one, making it the lowest known.

Other animals

Cattle, goats, and sheep are most commonly infected, and can serve as a reservoir for the bacteria. Q fever is a well-recognized cause of abortions in ruminants and pets. C. burnetii infection in dairy cattle has been well documented and its association with reproductive problems in these animals has been reported in Canada, the US, Cyprus, France, Hungary, Japan, Switzerland, and Germany. [29] For instance, in a study published in 2008, [30] a significant association has been shown between the seropositivity of herds and the appearance of typical clinical signs of Q fever, such as abortion, stillbirth, weak calves, and repeat breeding. Moreover, experimental inoculation of C. burnetii in cattle induced not only respiratory disorders and cardiac failures (myocarditis), but also frequent abortions and irregular repeat breedings. [31]

Related Research Articles

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Vaccine biological preparatory medicine that improves immunity to a particular disease

A vaccine is a biological preparation that provides active acquired immunity to a particular disease. A vaccine typically contains an agent that resembles a disease-causing microorganism and is often made from weakened or killed forms of the microbe, its toxins, or one of its surface proteins. The agent stimulates the body's immune system to recognize the agent as a threat, destroy it, and to further recognize and destroy any of the microorganisms associated with that agent that it may encounter in the future. Vaccines can be prophylactic, or therapeutic.

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Meningococcal disease Human disease

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  1. Beare PA, Samuel JE, Howe D, Virtaneva K, Porcella SF, Heinzen RA (April 2006). "Genetic diversity of the Q Fever agent, Coxiella burnetii, assessed by microarray-based whole-genome comparisons". J. Bacteriol. 188 (7): 2309–2324. doi:10.1128/JB.188.7.2309-2324.2006. PMC   1428397 . PMID   16547017.
  2. "Q fever | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program". rarediseases.info.nih.gov. Retrieved 2018-04-17.
  3. 1 2 "Q Fever | CDC". www.cdc.gov. 2017-12-27. Retrieved 2018-04-17.
  4. 1 2 Anderson, Alicia; McQuiston, Jennifer (2011). "Q Fever". In Brunette, Gary W. et al. CDC Health Information for International Travel: The Yellow Book. Oxford University Press. p. 270. ISBN   978-0-19-976901-8.CS1 maint: Uses editors parameter (link)
  5. Kuhne F, Morlat P, Riss I, et al. (1992). "Is A29, B12 vasculitis caused by the Q fever agent? (Coxiella burnetii)". J Fr Ophtalmol (in French). 15 (5): 315–21. PMID   1430809.
  6. Karakousis PC, Trucksis M, Dumler JS (June 2006). "Chronic Q Fever in the United States". J. Clin. Microbiol. 44 (6): 2283–7. doi:10.1128/JCM.02365-05. PMC   1489455 . PMID   16757641.
  7. Maurin M, Raoult D (October 1999). "Q fever". Clin. Microbiol. Rev. 12 (4): 518–53. PMC   88923 . PMID   10515901.
  8. Scola BL (October 2002). "Current laboratory diagnosis of Q Fever". Semin Pediatr Infect Dis. 13 (4): 257–262. doi:10.1053/spid.2002.127199. PMID   12491231.
  9. van de Veerdonk FL, Schneeberger PM (2006). "Patient with fever and diarrea". Clin Infect Dis. 42 (7): 1051–2. doi:10.1086/501027.
  10. "Q fever Vaccine" (PDF). CSL. 17 January 2014. Archived from the original on 9 March 2017. Retrieved 11 July 2015.CS1 maint: BOT: original-url status unknown (link)
  11. "Archived copy" (PDF). Archived from the original (PDF) on 2007-07-01. Retrieved 2007-05-08.CS1 maint: Archived copy as title (link)
  12. "Australian Q Fever Register". AusVet. Retrieved 12 February 2016.
  13. Camuset, P; Remmy, D (2008). "Q Fever (Coxiella burnetii) Eradication in a Dairy Herd by Using Vaccination with a Phase 1 Vaccine". Budapest: XXV World Buiatrics Congress.
  14. Hogerwerf, L; Van Den Brom, R; Roest, HI; Bouma, A; Vellema, P; Pieterse, M; Dercksen, D; Nielen, M (2011). "Reduction of Coxiella burnetii prevalence by vaccination of goats and sheep, the Netherlands". Emerging Infectious Diseases. 17 (3): 379–386. doi:10.3201/eid1703.101157. PMC   3166012 . PMID   21392427.
  15. Carcopino X, Raoult D, Bretelle F, Boubli L, Stein A (2007). "Managing Q fever during pregnancy: The benefits of long-term Cotrimoxazole therapy". Clin Infect Dis. 45 (5): 548–555. doi:10.1086/520661. PMID   17682987.
  16. Cutler SJ, Bouzid M, Cutler RR (April 2007). "Q fever". J. Infect. 54 (4): 313–8. doi:10.1016/j.jinf.2006.10.048. PMID   17147957.
  17. Domingo P, Muñoz C, Franquet T, Gurguí M, Sancho F, Vazquez G (October 1999). "Acute Q fever in adult patients: report on 63 sporadic cases in an urban area". Clin. Infect. Dis. 29 (4): 874–9. doi:10.1086/520452. PMID   10589906.
  18. Dupuis G, Petite J, Péter O, Vouilloz M (June 1987). "An important outbreak of human Q fever in a Swiss Alpine valley". Int J Epidemiol. 16 (2): 282–7. doi:10.1093/ije/16.2.282. PMID   3301708.
  19. "Q fever: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 2018-04-17.
  20. Derrick EH (1937). ""Q" Fever a new fever entity: clinical features. diagnosis, and laboratory investigation". Med J Aust. 11: 281–299.
  21. Joseph E. McDade (1990). "Historical aspects of Q Fever". In Thomas J. Marrie. Q Fever, Volume I: The Disease. CRC Press. p. 8. ISBN   0-8493-5984-8.
  22. Burnet FM, Freeman M (1937). "Experimental studies on the virus of "Q" fever". Med J Aust. 2: 299–305.
  23. Davis, Gordon E.; Cox, Herald R.; Parker and R. E. Dyer, R. R.; Dyer, R. E. (1938). "A Filter-Passing Infectious Agent Isolated from Ticks". Public Health Reports . Association of Schools of Public Health. 53 (52): 2259–82. doi:10.2307/4582746. ISSN   0094-6214. JSTOR   4582746 via JSTOR. (Registration required (help)).
  24. "Calling Dr. Kildare". Movie Mirrors Index. Retrieved 30 April 2013.
  25. Kalisch, PA; Kalisch, BJ (1985). "When Americans called for Dr. Kildare: images of physicians and nurses in the Dr. Kildare and Dr. Gillespie movies, 1937–1947" (PDF). Medical Heritage. 1 (5): 348–363. PMID   11616027 . Retrieved 30 April 2013.
  26. Madariaga MG, Rezai K, Trenholme GM, Weinstein RA (November 2003). "Q Fever: A biological weapon in your backyard". Lancet Infect Dis. 3 (11): 709–21. doi:10.1016/S1473-3099(03)00804-1. PMID   14592601.
  27. Deseret Test Center, Project SHAD, Shady Grove revised fact sheet
  28. Seshadri R, Paulsen IT, Eisen JA, et al. (April 2003). "Complete genome sequence of the Q-fever pathogen Coxiella burnetii". Proc. Natl. Acad. Sci. U.S.A. 100 (9): 5455–60. doi:10.1073/pnas.0931379100. PMC   154366 . PMID   12704232.
  29. To, H; Sakai, R; Shirota, K; Kano, C; Abe, S; Sugimoto, T; Takehara, K; Morita, C; Takashima, I; Maruyama, T; Yamaguchi, T; Fukushi, H; Hirai, K (1998). "Coxiellosis in domestic and wild birds from Japan". Journal of Wildlife Diseases. 34 (2): 310–6. doi:10.7589/0090-3558-34.2.310. PMID   9577778.
  30. Czaplicki, G; Houtain, JY; Mullender, C; Porter, SR; Humblet, MF; Manteca, C; Saegerman, C (2012). "Apparent prevalence of antibodies to Coxiella burnetii (Q fever) in bulk tank milk from dairy herds in southern Belgium". Veterinary journal (London, England : 1997). 192 (3): 529–31. doi:10.1016/j.tvjl.2011.08.033. PMID   21962829.
  31. Plommet, M; Capponi, M; Gestin, J; Renoux, G (1973). "Fièvre Q expérimentale des bovins". Annales de recherches vétérinaires (in French). 4 (2): 325–346.
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