Q Fever

a. Clinical Syndrome.

(1) Characteristics. Q fever is a zoonotic disease caused by a rickettsia, Coxiella burnetii. The most common animal reservoirs are sheep, cattle and goats. Humans acquire the disease by inhalation of particles contaminated with the organisms. A biological warfare attack would cause disease similar to that occurring naturally.

(2) Clinical Features. Following an incubation period of 10-20 days, Q fever generally occurs as a self-limiting febrile illness lasting 2 days to 2 weeks. Pneumonia occurs frequently, usually manifested only by an abnormal chest x-ray. A nonproductive cough and pleuritic chest pain occur in about onefourth of patients with Q fever pneumonia. Patients usually recover uneventfully. Uncommon complications include chronic hepatitis, endocarditis, aseptic meningitis, encephalitis, and osteomyelitis.

b. Diagnosis.

(1) Routine Laboratory Findings. The white blood cell count is elevated in one third of patients. Most patients with Q fever have a mild elevation of hepatic transaminase levels.

(2) Differential Diagnosis. Q fever usually presents as an undifferentiated febrile illness, or a primary atypical pneumonia, which must be differentiated from pneumonia caused by mycoplasma, legionnaire’s disease, psittacosis or Chlamydia pneumonia. More rapidly progressive forms of pneumonia may look like bacterial pneumonias including tularemia or plague.

(3) Specific Laboratory Diagnosis. Identification of organisms by staining sputum is not helpful. Isolation of the organism is difficult and impractical. The diagnosis can be confirmed serologically.

c. Therapy. Tetracycline (250 mg every 6 hr) or doxycycline (100 mg every 12 hr) for 5-7 days is the treatment of choice. A combination of erythromycin (500 mg every 6 hr) plus rifampin (600 mg per day) is also effective.

d. Prophylaxis. Vaccination with a single dose of a killed suspension of C. burnetii provides complete protection against naturally occurring Q fever and >90% protection against experimental aerosol exposure in human volunteers. Protection lasts for at least 5 years. Administration of this vaccine in immune individuals may cause severe cutaneous reactions including necrosis at the inoculation site. Newer vaccines are under development. Treatment with tetracycline during the incubation period will delay but not prevent the onset of illness.

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