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{{Q fever}}
{{Q fever}}
==Overview==
==Overview==
==History and Symptoms==
==Overview==
 
==History and symptoms==
*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:
*Incubation period is usually 2 to 3 weeks.
*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:
*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.
   
   
*The most common manifestation is flu-like symptoms with abrupt onset of:
====Hepatitis:====
*Abdominal right upper quadrant pain
*Jaundice
*GI symptoms as nausea, Malaise, 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.


**[[Fever]]: The fever lasts approximately 7-14 days.
===Chronic Q fever:===
**[[Malaise]]
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.  
**Profuse perspiration
**Severe [[headache]]
**[[Myalgia]] (muscle pain) 
**Joint pain
**Loss of appetite
**Upper respiratory problems
**Dry cough
**Pleuritic pain
**Chills,
**Confusion 
**Gastro-intestinal [[symptoms]] such as [[nausea]], vomiting and [[diarrhea]].
*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:
====Endocarditis:====
**Malaise
**Fever
Endocarditis is the main manifestation of Q fever.
**Liver enlargement (hepatomegaly)
*Characterized by being culture negative endocarditis.
**Pain in the right upper quadrant of the [[abdomen]]
*Patients who are predisposed to endocarditis include patients with valvular lesions, prosthetic valves and immunocompromised patients.
**[[Jaundice]] (icterus).
*Presents with:
 
**Low grade fevers
*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%
**Palpitations
 
**Dyspnea
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.
**Embolic manifestations
 
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>
====Skeletal manifestations:====
 
*Bone and joint infections are common manifestations of chronic Q fever.
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.
*Presents with:
 
**Low grade fever
Common symptoms include:
**Bone and joint pain as in chronic osteomyelitis
* Dry cough (nonproductive)
   
* Fever
====Vascular lesions:====
* Headache
*Usually in previously affected vessel (e.g. aneurysm)
* Joint pain (arthralgia)
* Muscle pains
====Cardiopulmonary affection:====
Other symptoms that may develop include:
*Chronic pleural or pericardial effusion and Interstitial pulmonary fibrosis present with dyspnea and fatigue.
* Abdominal pain
* Chest pain
====Hepatic manifestations:====
* Jaundice
*Liver fibrosis or cirrhosis presents with symptoms of chronic hepatic decompensation (e.g jaundice, abdominal pain, fatigue, etc)
* Rash
====Chronic fatigue syndrome:====
*Presents in up to 10% of chronic Q fever patients.


==References==
==References==

Revision as of 17:08, 5 June 2017

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Overview

Overview

History and symptoms

  • 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:
  • 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:

  • 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, Malaise, 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:

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.

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.

References


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