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| ==History and Symptoms==
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| *Incubation period is usually 2 to 3 weeks.
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| *The most common manifestation is flu-like symptoms with abrupt onset of:
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| **[[Fever]]: The fever lasts approximately 7-14 days.
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| **[[Malaise]]
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| **Profuse perspiration
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| **Severe [[headache]]
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| **[[Myalgia]] (muscle pain)
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| **Joint pain
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| **Loss of appetite
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| **Upper respiratory problems
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| **Dry cough
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| **Pleuritic pain
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| **Chills,
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| **Confusion
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| **Gastro-intestinal [[symptoms]] such as [[nausea]], vomiting and [[diarrhea]].
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| *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.
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| *Less often the Q fever causes (granulomatous) [[hepatitis]] which becomes symptomatic with:
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| **Malaise
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| **Fever
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| **Liver enlargement (hepatomegaly)
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| **Pain in the right upper quadrant of the [[abdomen]]
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| **[[Jaundice]] (icterus).
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| *The chronic form of the Q fever is virtually identical with [[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%
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| 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.
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| 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=1051–2 }}</ref>
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| 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.
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| Common symptoms include:
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| * Dry cough (nonproductive)
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| * Fever
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| * Headache
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| * Joint pain (arthralgia)
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| * Muscle pains
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| Other symptoms that may develop include:
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| * Abdominal pain
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| * Chest pain
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| * Jaundice
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| * Rash
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