Sandbox: q fever
Q fever can present with a wide variety of symptoms related to multiple organs involved. Q fever can be classified into acute and chronic based on the onset of symptoms:
Acute Q fever:
Flu like symptoms: High grade fevers: Fever is usually accompanied by chills and night sweats. Headaches: retrobulbar and associated with photophobia. Arthralgias.
Pneumonia: Usually mild and accidentally discovered on X rays If accompanied by cough, cough is dry and non productive. Dyspnea Pleuritic chest pain Rarely progresses to ARDS which can be life threatening.
Hepatitis: Abdominal right upper quadrant pain Jaundice GI symptoms as nausea, vomiting, diarrhea and bloating.
Rare acute Q fever symptoms:
Pericarditis and myocarditis: Myocarditis is rare but carries a bad prognosis. Chest pain Dyspnea Palpitation
Neurologic findings: Q fever can present with meningioencephalitis. Headache Confusion Seizures
Dermatologic findings: Maculopapular rash Diffuse punctate rash Erythema nodosum
Q fever during pregnancy: Most C. brutenii infection during pregnancy pass asymptomatic but in rare cases it can be complicated with: Intrauterine growth retardation (IUGR) Intrauterine fetal death (IUFD).
Infection during first trimester and placental infection are associated with increased risk of fetal compromise.
Chronic Q fever:
Endocarditis:
Endocarditis is the main manifestation of Q fever. Characterized by being culture negative endocarditis. Patients who are predisposed to endocarditis include patients with valvular lesions, prosthetic valves and immunocompromised patients. Presents with:
- Low grade fevers
- Palpitations
- Dyspnea
- Embolic manifestations
Skeletal manifestations: Bone and joint infections are common manifestations of chronic Q fever. Presents with:
- Low grade fever
- Bone and joint pain as in chronic osteomyelitis
Vascular lesions: Usually in previously affected vessel (e.g. aneurysm)
Cardiopulmonary affection: Chronic pleural or pericardial effusion and Interstitial pulmonary fibrosis present with dyspnea and fatigue.
Hepatic manifestations: Liver fibrosis or cirrhosis presents with symptoms of chronic hepatic decompensation (e.g jaundice, abdominal pain, fatigue, etc)
Chronic fatigue syndrome: Presents in up to 10% of chronic Q fever patients.