Q Fever – Symptoms, Causes, and Treatment
Q fever is a zoonosis. The causative agent is Coxiella burnetii bacteria. Sheep, goats and cattle in the country are mainly infected with this pathogen. Q fever is usually acute with flu-like symptoms. Chronic conditions are very rare. Most Q fever patients recover spontaneously without treatment.
Other names are Queensland fever, Cretan fever, Crimean fever, Euboea fever, desert fever and Balkan fever or Balkan flu. Commonly speaking, Q fever is called seven-day fever, slaughterhouse fever or goat flu.
Queensland (Australia) tick typhus has nothing to do with Q fever. This disease is caused by bacteria from the rickettsial family.
Q Fever Spreads Almost All Over the World
Q fever is common almost all over the world. Only in New Zealand and Antarctica there are no cases of this zoonosis. Typically, people get Q fever while taking care of animals. Cattle farmers and livestock owners, as well as veterinarians, butchers and animal fur handlers are therefore most often affected.
Q Fever Incidence
The most qualified country in terms of prevalence data is Germany. Q fever diseases are reported to the health department every year in Germany. Data are collected and evaluated at the Robert Koch Institute (RKI). RKI recorded a total of 93 cases in 2018. The infection rate was significantly high between 2013 and 2015. After 115 Q fever cases in 2013, there were 262 cases in 2014 and 320 cases were recorded in 2015. In 2015, a village festival in Swabian Alb was canceled due to an increase in the number of Q fever disease.
Q Fever Symptoms
After an incubation period of 2 to 3 weeks (ie the time from infection to the first symptoms of the disease), a severe Q fever course begins with rapidly rising fever and chills. Fever usually lasts 1 to 2 weeks. It is usually accompanied by severe muscle and forehead headaches. Half of all Q fever illnesses go unnoticed without any symptoms, and symptoms resolve after 1 to 2 weeks.
Complications of Acute Q Fever
The other half may experience life-threatening complications after starting with severe flu-like symptoms. Lung infections (pneumonia) or liver infections (hepatitis) are possible. Sometimes there is inflammation of the heart muscle (myocarditis), pericarditis (pericarditis) and encephalitis and meningitis (meningoencephalitis). Some of these complications can be fatal without proper treatment. Timely treatment with antibiotics very clearly increases the chances of recovery.
Chronic Q Fever
1 percent of Q fever infections become chronic. The bacteria then nests in different organs over months and years. The infection comes back suddenly 6 months to 10 years (or longer) after the initial infection. The most common is Q fever endocarditis. This is an inflammation of the inner lining of the heart where pathogens settle in the heart valves. If the body’s immune system is weakened or you have heart valve disease, the risk of such an infection increases. In rare cases, chronic Q fever causes other chronic infections such as bones, lungs, or liver.
Q Fever During Pregnancy
With Q fever during pregnancy, pathogens can be transmitted to the unborn child through the placenta. Infection is associated with a significantly increased risk of preterm birth and miscarriage. The risk of miscarriage is particularly high if you become infected with Q fever during the first trimester of pregnancy.
- Q fever in pregnant women often leads to chronic organ or bone infections.
Causes of Q Fever
The bacterium that causes Q fever is called Coxiella burnetii. Humans are mainly transmitted by inhaling infected dust from rotted animal feces. The contagiousness of pathogens is extremely high and their range is very wide. Infection is possible even if animals are kept at a distance of up to 2 km. And: a single bacterium is enough to trigger a Q fever infection.
Pathogens are not only transmitted through faeces. They can also be passed on to humans through direct contact with infected animals and when handling infected meat.
It is theoretically possible to become infected through foods such as raw milk or cheese as well as foods such as wool, but it is very rare in practice.
Q Fever Treatment
Q fever is relatively easy to treat with antibiotics. The antibiotic doxycycline, which should be taken for up to 3 weeks, is particularly suitable. Doctors may also prescribe other antibiotics such as clarithromycin or fluoroquinolones (another group of antibiotics) such as levofloxacin or moxifloxacin. The broad spectrum antibiotic chloramphenicol and the anti-malarial drug hydrochloroquine are also effective against Q fever.
Chronic Q fever should be combined with doxycycline, levofloxacin, moxifloxacin or rifampicin. Duration of treatment is at least 12 months. Pregnant women with Q fever infection are treated with the antibiotic trimethoprim-sulfamethoxazole for the entire duration of pregnancy.
