Q fever
Signs and Symptoms
The following symptoms are commonly seen in patients with acute Q fever. However, it is important to note that the combination of signs and symptoms vary from person to person. Some patients may not have any symptoms following infection.Fever
Fatigue
Headache
Malaise
Myalgia
Chills or sweats
Cough
Nausea
Vomiting
Diarrhea
Chest pain
Clinical assessment
Q fever is challenging for healthcare providers to diagnose and treat. The symptoms are non-specific and there is variability of presentation from patient to patient, making it difficult to distinguish from other diseases. Serology will frequently be negative in the first 2 weeks of illness. As serology is expected to be negative early in the illness course, treatment should be initiated based on clinical suspicion rather than waiting for the results of confirmatory serologic testing. Detection of Coxiella burnetii DNA by polymerase chain reaction (PCR) can rapidly confirm an acute Q fever infection. Samples are ideally taken during the first 2 weeks of illness and before or shortly following doxycycline administration. In the first 2 weeks of illness it is recommended to use serologic tests in combination with PCR of whole blood or serum. Treatment should be initiated as soon as Q fever is suspected and should not be withheld pending diagnostic test results.
Complications
Most people with acute Q fever infection recover completely; however, some may experience serious illness with pneumonia, granulomatous hepatitis, myocarditis, or central nervous system complications.
Pregnant people who are infected (even without clinical illness) may be at risk for miscarriage, stillbirth, pre-term delivery, or low infant birth weight.
Chronic Q fever occurs in <5% of patients infected with Coxiella burnetii. It may present within weeks after an acute infection or may manifest many years later. Anyone who was infected with Coxiella burnetii is at risk for developing chronic Q fever; however, people with a history of valvular heart defects, arterial aneurysms, or vascular grafts are at increased risk. People infected by Coxiella burnetii during pregnancy and those with immunosuppression are also at increased risk of developing chronic Q fever.
Endocarditis is the most commonly identified manifestation of chronic Q fever and is fatal if untreated. Patients with endocarditis require long-term antibiotic treatment (at least 18 months) for a successful outcome. Other forms of chronic Q fever include infections of bone, liver, vascular aneurysms, or reproductive organs.
Website: International Conference on Infectious Diseases.
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