Q fever history and symptoms
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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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 fever: Fever is usually accompanied by chills and 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 acute respiratory distress syndrome (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 meningoencephalitis
- 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:
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.