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{{Q fever}}
{{Q fever}}
==Overview==
Acute Q fever presents with [[Flu|flu-like symptoms]], [[pneumonia]], and [[hepatitis]]. [[Chronic]] Q fever almost always presents with [[endocarditis]] and sometimes has [[musculoskeletal]] and [[vascular]] manifestations.


==History and symptoms==
==History and symptoms==
Incubation period is usually 2 to 3 weeks.
*Q fever can present with a wide variety of symptoms based on the multiple organs involved. Q fever can be classified as acute or [[chronic]] based on the onset of symptoms.<ref name="pmid88923">{{cite journal |vauthors=Ishikawa H, Maeda H, Takamatsu H, Saito Y |title=Systemic hyalinosis (juvenile hyaline fibromatosis). Ultrastructure of the hyaline with particular reference to the cross-banded structure |journal=Arch. Dermatol. Res. |volume=265 |issue=2 |pages=195–206 |year=1979 |pmid=88923 |doi= |url=}}</ref><ref name="pmid1489455">{{cite journal |vauthors=Choyce DP |title=Anterior chamber lens exchange |journal=J Cataract Refract Surg |volume=18 |issue=5 |pages=537 |year=1992 |pmid=1489455 |doi= |url=}}</ref>
The most common manifestation is flu-like symptoms with abrupt onset of [[fever]], [[malaise]], profuse perspiration, severe [[headache]], [[myalgia]] (muscle pain), joint pain, loss of appetite, upper respiratory problems, dry cough, pleuritic pain, chills, confusion and gastro-intestinal [[symptoms]] such as [[nausea]], vomiting and [[diarrhea]]. The fever lasts approximately 7-14 days.
*The [[incubation period]] is usually 2 to 3 weeks.
 
During the course, the disease can progress to an atypical [[pneumonia]], which can result in a life threatening [[acute respiratory distress syndrome]] (ARDS), whereby such symptoms usually occur during the first 4-5 days of infection.
 
Less often the Q fever causes (granulomatous) [[hepatitis]] which becomes symptomatic with malaise, fever, liver enlargement (hepatomegaly), pain in the right upper quadrant of the [[abdomen]] and [[jaundice]] (icterus).  


The chronic form of the Q fever is virtually identical with the [[inflammation]] of the inner lining of the heart ([[endocarditis]]), which can occur after months or decades following the infection. It is usually deadly if untreated. However, with appropriate treatment this lethality is around 10%
===Acute Q fever===
====Flu-like symptoms====
The most common manifestation is [[flu|flu-like symptoms]] with abrupt onset of:
*[[Fever|High grade fever]]: Fever is usually accompanied by [[chills]] and sweats<ref name="pmid18452690">{{cite journal |vauthors=Hartzell JD, Wood-Morris RN, Martinez LJ, Trotta RF |title=Q fever: epidemiology, diagnosis, and treatment |journal=Mayo Clin. Proc. |volume=83 |issue=5 |pages=574–9 |year=2008 |pmid=18452690 |doi=10.4065/83.5.574 |url=}}</ref>
*[[Headache|Headaches]]:  Retrobulbar and associated with [[photophobia]]
*[[Arthralgia|Arthralgias]]
====Pneumonia====
Usually mild and accidentally discovered on [[X-rays]]
*If accompanied by a [[cough]], the cough is dry and nonproductive<ref name="pmid2731605">{{cite journal |vauthors=Sobradillo V, Ansola P, Baranda F, Corral C |title=Q fever pneumonia: a review of 164 community-acquired cases in the Basque country |journal=Eur. Respir. J. |volume=2 |issue=3 |pages=263–6 |year=1989 |pmid=2731605 |doi= |url=}}</ref>
*[[Dyspnea]]
*[[Pleuritic chest pain]]
*Rarely progresses to [[Acute respiratory distress syndrome|acute respiratory distress syndrome (ARDS)]], which can be life threatening
====Hepatitis====
*[[Right upper quadrant pain|Abdominal right upper quadrant pain]]
*[[Jaundice]]
*[[Gastrointestinal tract|GI]] symptoms including [[nausea]], [[malaise]], [[vomiting]], [[diarrhea]], and [[bloating]].
===Rare acute Q fever symptoms===


Only about one-half of all people infected with C. burnetii show signs of clinical illness. Most acute cases of Q fever begin with sudden onset of one or more of the following: high [[fever]]s (up to 104-105° F), severe [[headache]], general malaise, [[myalgia]], [[confusion]], sore throat, chills, sweats, non-productive [[cough]], [[nausea]], [[vomiting]], [[diarrhea]], [[abdominal pain]], and [[chest pain]]. Fever usually lasts for 1 to 2 weeks. [[Weight loss]] can occur and persist for some time. Thirty to fifty percent of patients with a symptomatic infection will develop [[pneumonia]]. Additionally, a majority of patients have abnormal results on liver function tests and some will develop [[hepatitis]]. In general, most patients will recover to good health within several months without any treatment. Only 1%-2% of people with acute Q fever die of the disease.
====Pericarditis and myocarditis====
*[[Myocarditis]] is rare but is associated with a bad prognosis<ref name="pmid6622891">{{cite journal |vauthors=Derrick EH |title="Q" fever, a new fever entity: clinical features, diagnosis and laboratory investigation |journal=Rev. Infect. Dis. |volume=5 |issue=4 |pages=790–800 |year=1983 |pmid=6622891 |doi= |url=}}</ref>
*[[Chest pain]]
*[[Dyspnea]]
*[[Palpitation]]


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 1 year or as long as 20 years after initial infectioQ-fever can cause [[endocarditis]] (infection of the heart valves) which may require [[Echocardiography#Transesophageal_echocardiogram|transoesophageal echocardiography]] to diagnose. Most patients who develop chronic Q fever have pre-existing valvular heart disease or have a history of vascular graft. Transplant recipients, patients with [[cancer]], and those with chronic kidney disease are also at risk of developing chronic Q fever. As many as 65% of persons with chronic Q fever may die of the disease. Q-fever [[hepatitis]] manifests as an elevation of [[Alanine transaminase|ALT]] and [[Aspartate transaminase|AST]], but a definitive diagnosis is only possible on liver biopsy which shows the characteristic [[fibrin ring granuloma]]s.<ref>{{cite journal | title=Patient with fever and diarrea | author=van de Veerdonk FL, Schneeberger PM. | journal=Clin Infect Dis | year=2006 | volume=42 | pages=1051&ndash;2 }}</ref>
====Neurologic findings====
*Q fever can present with [[meningoencephalitis]]
*[[Headache]]
*[[Confusion]]
*[[Seizures]]
====Dermatologic findings====
*[[Maculopapular rash]]
*[[Rash|Diffuse punctate rash]]
*[[Erythema nodosum]]
   
====Q fever during pregnancy====
Most [[Coxiella burnetii|''C. brutenii'']] [[infections]] during pregnancy are [[asymptomatic]] but in rare cases, can cause:
*[[Intrauterine growth retardation|Intrauterine growth retardation (IUGR)]]<ref name="pmid9770161">{{cite journal |vauthors=Stein A, Raoult D |title=Q fever during pregnancy: a public health problem in southern France |journal=Clin. Infect. Dis. |volume=27 |issue=3 |pages=592–6 |year=1998 |pmid=9770161 |doi= |url=}}</ref>
*Intrauterine fetal death (IUFD)
*[[Abortion]]
Infection during [[first trimester]] and [[placental]] infection are associated with increased risk of fetal compromise.


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 against re-infection.
===Chronic Q fever===
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 1 year or as long as 20 years after initial [[infection]].<ref name="pmid1489455">{{cite journal |vauthors=Choyce DP |title=Anterior chamber lens exchange |journal=J Cataract Refract Surg |volume=18 |issue=5 |pages=537 |year=1992 |pmid=1489455 |doi= |url=}}</ref>


Common symptoms include:
====Endocarditis====
* Dry cough (nonproductive)
* Fever
[[Endocarditis]] is the main manifestation of Q fever.
* Headache
*Characterized by being [[Endocarditis|culture negative endocarditis]]
* Joint pain (arthralgia)
*Patients who are predisposed to [[endocarditis]] include patients with [[Valvular heart disease|valvular lesions]], [[prosthetic valves]], and [[Immunocompromised|immunocompromised patients]]
* Muscle pains
*Presents with:
Other symptoms that may develop include:
**[[Low-grade fever|Low grade fever]]
* Abdominal pain
**[[Palpitations]]
* Chest pain
**[[Dyspnea]]
* Jaundice
**[[Embolic|Embolic manifestations]]
* Rash
====Skeletal manifestations====
*[[Bone]] and [[joint]] infections are common manifestations of [[chronic]] Q fever
*Presents with:
**[[Low-grade fever|Low grade fever]]
**[[Bone pain|Bone]] and [[joint pain]] as in chronic [[osteomyelitis]]
====Vascular lesions====
*Usually in previously affected vessel (e.g. [[aneurysm]])
====Cardiopulmonary effects====
*[[Chronic]] [[pleural]] or [[pericardial]] effusion and interstitial [[pulmonary fibrosis]] present with [[dyspnea]] and [[fatigue]]
====Hepatic manifestations====
*[[Hepatic fibrosis|Liver fibrosis]] or [[cirrhosis]] presents with symptoms of chronic [[Hepatic failure|hepatic decompensation]] (e.g [[jaundice]], [[abdominal pain]] and [[fatigue]])
====Chronic fatigue syndrome====
*Presents in up to 10% of chronic Q fever patients


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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Latest revision as of 23:55, 29 July 2020


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Ahmed Younes M.B.B.CH [2]

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Overview

Acute Q fever presents with flu-like symptoms, pneumonia, and hepatitis. Chronic Q fever almost always presents with endocarditis and sometimes has musculoskeletal and vascular manifestations.

History and symptoms

  • Q fever can present with a wide variety of symptoms based on the multiple organs involved. Q fever can be classified as acute or chronic based on the onset of symptoms.[1][2]
  • The incubation period is usually 2 to 3 weeks.

Acute Q fever

Flu-like symptoms

The most common manifestation is flu-like symptoms with abrupt onset of:

Pneumonia

Usually mild and accidentally discovered on X-rays

Hepatitis

Rare acute Q fever symptoms

Pericarditis and myocarditis

Neurologic findings

Dermatologic findings

Q fever during pregnancy

Most C. brutenii infections during pregnancy are asymptomatic but in rare cases, can cause:

Infection during first trimester and placental infection are associated with increased risk of fetal compromise.

Chronic Q fever

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 1 year or as long as 20 years after initial infection.[2]

Endocarditis

Endocarditis is the main manifestation of Q fever.

Skeletal manifestations

Vascular lesions

  • Usually in previously affected vessel (e.g. aneurysm)

Cardiopulmonary effects

Hepatic manifestations

Chronic fatigue syndrome

  • Presents in up to 10% of chronic Q fever patients

References

  1. ↑ Ishikawa H, Maeda H, Takamatsu H, Saito Y (1979). "Systemic hyalinosis (juvenile hyaline fibromatosis). Ultrastructure of the hyaline with particular reference to the cross-banded structure". Arch. Dermatol. Res. 265 (2): 195–206. PMID 88923.
  2. ↑ 2.0 2.1 Choyce DP (1992). "Anterior chamber lens exchange". J Cataract Refract Surg. 18 (5): 537. PMID 1489455.
  3. ↑ Hartzell JD, Wood-Morris RN, Martinez LJ, Trotta RF (2008). "Q fever: epidemiology, diagnosis, and treatment". Mayo Clin. Proc. 83 (5): 574–9. doi:10.4065/83.5.574. PMID 18452690.
  4. ↑ Sobradillo V, Ansola P, Baranda F, Corral C (1989). "Q fever pneumonia: a review of 164 community-acquired cases in the Basque country". Eur. Respir. J. 2 (3): 263–6. PMID 2731605.
  5. ↑ Derrick EH (1983). ""Q" fever, a new fever entity: clinical features, diagnosis and laboratory investigation". Rev. Infect. Dis. 5 (4): 790–800. PMID 6622891.
  6. ↑ Stein A, Raoult D (1998). "Q fever during pregnancy: a public health problem in southern France". Clin. Infect. Dis. 27 (3): 592–6. PMID 9770161.


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