Q Fever- Symptoms, Causes, Complications, And Treatment

The Q fever was first discovered in Australia in 1935 and the United States in the 1940s as an official human disease. The “Q” in Q fever refers to the word “query” which was given when the cause of the disease was unknown.

Coxiella burnetii or C. burnetii is the root cause of Q fever. The bacteria are usually transmitted through the respiratory tract by breathing in the dust that contains the bacteria of the infected animal.

C. burnetii are mostly found in animals like goats, sheep, and cattle which are located in the southern states of America like California, Texas, and Iowa, where cattle is quite a common occupational choice.

Although it is a respiratory disease, direct contact ( get licked or touching) with the infected animal will not give you Q fever, but consumption of contaminated and unpasteurized dairy products.

The bacteria breed themselves in birth organs (placenta, amniotic fluid) and by-products like urine, feces, and milk of infected animals.

The nature of bacteria is rare to spread through blood transfusion or sexual intercourse within animals, so it is not important for the offspring of the infected animal to possess the same disease.

C. burnetii is not only a bacteria that causes Q fever but also is a potential bioterrorism agent. The bioterrorism agent is known to create a critical condition called a biological attack, or bioterrorism.

In this case, the bacteria develop an intentional release in the body that suddenly sickens or contaminates the contacted person, crop, or area.

C. burnetii or its bioterrorism agent is highly dangerous, as it just needs less than 10 bacterial cultures to sicken or kill an individual. Furthermore, the bacteria are highly resistant to common disinfectant methods like boiling or drying.

Some people never get sick, especially when being around farm animals is part of their lifestyle. Work fields like meat processing plant workers, veterinarians, livestock farmers, dairy workers, and researchers at facilities housing sheep and goats tend to develop immunity towards Q fever.

Also, the spring and early summers are the breeding seasons or birthing seasons for cattle, sheep, and goats, which makes the bacteria more contagious.

However, people with low immunity might develop flu-like symptoms and may need to take extra precautions, especially Men with older age or female who are pregnant or expecting to be as may cause miscarriage, pre-term delivery, stillbirth, or low infant birth weight.

If exposed to the Coxiella burnetii, there is a 50% chance that one might get sick with Q fever. The bacteria usually takes two to three weeks to show its initial symptoms. These symptoms may include:

• Non-productive cough
• Muscle aches
• Vomiting, nausea, Or diarrhea
• Chest pain
• Fatigue (tiredness)
• Weight loss
• Chills or sweats
• Headache
• Fever
• Stomach pain

The severity of the disease depends on the infected area of your body. For instance, if the bacteria start to multiply in one’s lungs or liver it might end with life-threatening diseases like pneumonia and hepatitis.

In most of the cases of Q fever within a short period. Acute Q fever is easy to cure and exhibits general symptoms only, if not treated on time, it can develop the bacteria to an advanced level, which can lead to a chronic case of Q fever.

Acute Q fever patients can also go under critical diseases like pneumonia, myocarditis, granulomatous hepatitis, or central nervous system complications.

Chronic cases of Q fever are rare to find and less than 5% of acute cases have a probability of converting into chronic cases. It might take several months or even years to reflect Q fever symptoms.

Chronic Q fever can also lead to endocarditis. It is a severe case in which one or more heart valves get infected with C. burnetii. Patients with endocarditis may exhibit symptoms like:

• Weight loss
• Swelling of their limbs
• Fatigue
• Night sweats
• Shortness of breath

Endocarditis is not easy to detect, it is advisable to seek a medical professional to diagnose the same. Your medical advisor may conduct a series of tests to confirm the diagnosis. Also, Chronic Q fever is susceptible to those who are suffering from blood vessel abnormalities, heart valve disease, or weakened immune systems.

It can develop a critical condition if not treated well. The treatment of Chronic Q fever requires a combination of antibiotics.

The symptoms of Q fever are identical to various diseases. So it can be difficult for your healthcare professional to identify the disease through general medical examination of medical history.

One may create a hypothesis if the patient recently spent time with farm animals, especially sheep, goats, and cattle, or has a high-risk occupation involving the same.

To detect the presence of Coxiella burnetii in your body, the doctor may advise you to have your blood tested for Q fever. Diagnoses of the test are mostly based on detecting antibodies that will frequently appear negative in the initial 7-15 days of infection.

So, To be on the safe side, your doctor might prescribe you some general antibiotics until the diagnosis of the blood test completes.

C. burnetii can be detected by polymerase chain reaction (PCR) in the DNA that can confirm the presence of acute Q fever infection. Blood Samples usually get collected in the initial 2 weeks and after doxycycline administration.

For a definitive diagnosis, doctors advise you to take a combination test, which includes:

1. Serologic:

   This refers to a standard test that diagnoses the presence of acute Q fever using C. burnetii antigen and indirect immunofluorescence antibody. The test was conducted through a serum sample which was paired with the bacteria to demonstrate the rise in antibody titers.

   The first sample has to be taken within the first week of contamination and the second one after 3-6 weeks. Since in most of the cases the first test always shows a negative or reduced level of antibody which shows no signs of Q fever. The second test becomes mandatory which shows an increased level of the antibody as compared to the first one.

2. PCR:

   In this test, a sample of whole blood or serum will be tested to diagnose polymerase chain reaction to determine the presence of bacteria responsible for Q fever. This method can be sensitive during the first week of illness or before the appearance of antibodies.

   A positive PCR result can be helpful for an effective treatment, a negative result also does not declare the exact result of the diagnosis. In case of negative results, your doctor might not withhold the outgoing treatment as the development of antibodies might take a little while.

Apart from these tests, your doctor might look for other body reactions that may confirm the presence and severity of Q fever in the body. These may include:

• Low platelet count
• Leukocyte count
• Liver enzymes
• Blood cell count

Since the bacterial disease can cause major illness to the patient, it is mandatory to have an immediate execution of the treatment if the test result shows the presence of Acute Q fever.

Chronic Q fever is confirmed by the diagnosis of elevated levels of antibodies and a remarkable presence of endocarditis. In this case, the whole blood, serum, or tissue biopsies will be conducted through PCR for the diagnosis of C. burnetii.

Patients with chronic Q fever are mostly diagnosed with low sensitivity in endocarditis. So, It is crucial to diagnose whole blood serum antibody titers with PCR. Immunohistochemistry of biopsy for specimens for the infected area can also be done to diagnose chronic Q fever.

Patients undergoing medical treatment like valve replacement surgery or hepatitis can be diagnosed with this test for a safer result.

Most people who are infected with Q fever bacteria gradually recover without antibiotic treatment within a few days. However, it is recommended that people with Q fever disease can be cured with antibiotics like doxycycline.

Doxycycline is mostly used to treat first-line bacterial infections for adults with Q fever. It is most effective in curing severe complications that occur within the first 3 days of surface symptoms.

Treatment must be based on the clinical diagnosis that must begin before the arrival of laboratory results. The Q fever generally fades within 72 hours, if the patient shows signs of recovery within the first 3 days of treatment.

In some critical conditions, the patients might require longer periods of treatment before the fever resolves. The type of treatment is not recommended for asymptomatic patients or people with a high risk of developing chronic Q fever.

Since, there is no specific role for prophylactic antimicrobial agents that provides any prevention against the Q fever after a naturally occurring exposure, medicine like Doxycycline needs to be consumed under doctor's consultation.

• Doxycycline:

  Mostly used to treat adults every 12 hours for the next 14 days. Children 8 years or older with high-risk criteria for preexisting heart valvulopathy, immunocompromised or delayed treatment for Q fever or can also be treated with the same.

• Trimethoprim/sulfamethoxazole:

  Recommended for pregnant women twice a day for the next 32 weeks. Or the children under or equal to 8 years with uncomplicated mild illness.

Since Chronic Q fever is known for its life-threatening infection, it may require several months of antibiotic treatment to permanently cure the bacteria of the body. This can be done with the combination of doxycycline and hydroxychloroquine for an advisable amount of time.

The treatment of chronic Q fever is mostly designed on serological test reports with evidence of improvement. Patients should be diagnosed with Serologic monitoring for chronic Q fever should be done to track the treatment progress.

• Doxycycline:

  Adults with endocarditis or vascular infection can take a 200 mg dose every 8 hours, for a minimum 18 month period.

• Hydroxychloroquine:

  Women with titers elevated after 12 months post-delivery can take a 200 mg dose in 8 hours gap frequency, for at least 18 months duration.

Before consuming doxycycline you may need to consider a medical health professional for any side effects or consider other antibiotics such as moxifloxacin, trimethoprim/sulfamethoxazole, clarithromycin, and rifampin.

The United States does not have any vaccines that are 100% effective to cure The Coxiella burnetii that causes Q fever. Avoid contact with goats, sheep, and cattle. These animals are highly susceptible to spread Q fever through direct consumption of contaminated or unpasteurized dairy products.

The bacteria also breed in the birth organs of the animals like placenta or amniotic fluid and by-products like urine or feces-infected animals.

One can reduce the risk of getting infected with Q fever by avoiding contact with animals while they are pregnant or giving birth. Animals carrying Coxiella burnetii bacteria might look healthy.

Patients with the medical history of heart valve disease, blood vessel abnormalities, a weakened immune system should take extra prevention of developing chronic Q fever as they are at high risk of getting infected.