Clinical manifestations and diagnosis of Q fever
- Didier Raoult, MD, PhD
Didier Raoult, MD, PhD
- Faculté de Médecine
- Aix Marseille Université
Q fever is a zoonotic infection caused by the pathogen Coxiella burnetii, and patients can present with a wide spectrum of clinical manifestations . The designation Q fever (from Query) was made in 1935 following an outbreak of a febrile illness among abattoir (slaughterhouse) workers in Queensland, Australia. The name remains apt, however, since many questions persist about this special organism and unusual disease. Q fever is reportable in the United States and its agent, C. burnetii, is a potential agent of bioterrorism .
The clinical manifestations and diagnosis of Q fever will be reviewed here. Topic reviews that discuss the microbiology, epidemiology, treatment, and prevention of Q fever, as well as Q fever endocarditis, are found elsewhere. (See "Microbiology and epidemiology of Q fever" and "Treatment and prevention of Q fever" and "Q fever endocarditis".)
Patients with Q fever present with a wide spectrum of disease manifestations. While for some patients the clinical manifestations of acute or chronic infection are severe , the clinical signs and symptoms of Q fever are mild or absent in others [3,4]. As an example, an outbreak of 415 cases of Q fever occurred in Switzerland, and among those infected, 224 (54 percent) were asymptomatic and only 2 percent were hospitalized.
Factors that can affect the clinical presentation include:
●Age and gender — Symptomatic infection is more likely to occur in adults compared with children and in men compared with women . In an outbreak in France, surveillance data were obtained to describe variations in the clinical presentation of acute infection according to specific host factors, as well as monitor progression from acute to chronic disease . Serum samples were obtained from over 1000 individuals. Acute Q fever was diagnosed serologically in 101 (9.3 percent). Adult men were most likely to be symptomatic, followed by adult women, and children ≤14 years of age. Pregnant women were the least likely to be symptomatic (ie, 1 of 11 women). Five percent (5/101) patients developed chronic disease, most had no known risk factors (eg, pregnancy, heart disease, immunocompromise).To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Raoult D, Marrie T. Q fever. Clin Infect Dis 1995; 20:489.
- Raoult D, Marrie T, Mege J. Natural history and pathophysiology of Q fever. Lancet Infect Dis 2005; 5:219.
- Hartzell JD, Wood-Morris RN, Martinez LJ, Trotta RF. Q fever: epidemiology, diagnosis, and treatment. Mayo Clin Proc 2008; 83:574.
- Dupuis G, Petite J, Péter O, Vouilloz M. An important outbreak of human Q fever in a Swiss Alpine valley. Int J Epidemiol 1987; 16:282.
- Tissot-Dupont H, Vaillant V, Rey S, Raoult D. Role of sex, age, previous valve lesion, and pregnancy in the clinical expression and outcome of Q fever after a large outbreak. Clin Infect Dis 2007; 44:232.
- Raoult D, Tissot-Dupont H, Foucault C, et al. Q fever 1985-1998. Clinical and epidemiologic features of 1,383 infections. Medicine (Baltimore) 2000; 79:109.
- Brouqui P, Dupont HT, Drancourt M, et al. Chronic Q fever. Ninety-two cases from France, including 27 cases without endocarditis. Arch Intern Med 1993; 153:642.
- Glazunova O, Roux V, Freylikman O, et al. Coxiella burnetii genotyping. Emerg Infect Dis 2005; 11:1211.
- Eldin C, Mahamat A, Demar M, et al. Q fever in French Guiana. Am J Trop Med Hyg 2014; 91:771.
- Edouard S, Mahamat A, Demar M, et al. Comparison between emerging Q fever in French Guiana and endemic Q fever in Marseille, France. Am J Trop Med Hyg 2014; 90:915.
- Epelboin L, Chesnais C, Boullé C, et al. Q fever pneumonia in French Guiana: prevalence, risk factors, and prognostic score. Clin Infect Dis 2012; 55:67.
- Fournier PE, Marrie TJ, Raoult D. Diagnosis of Q fever. J Clin Microbiol 1998; 36:1823.
- Million M, Raoult D. The pathogenesis of the antiphospholipid syndrome. N Engl J Med 2013; 368:2335.
- Million M, Thuny F, Bardin N, et al. Antiphospholipid Antibody Syndrome With Valvular Vegetations in Acute Q Fever. Clin Infect Dis 2016; 62:537.
- Fournier PE, Etienne J, Harle JR, et al. Myocarditis, a rare but severe manifestation of Q fever: report of 8 cases and review of the literature. Clin Infect Dis 2001; 32:1440.
- Bernit E, Pouget J, Janbon F, et al. Neurological involvement in acute Q fever: a report of 29 cases and review of the literature. Arch Intern Med 2002; 162:693.
- Marrie TJ, Raoult D. Q fever--a review and issues for the next century. Int J Antimicrob Agents 1997; 8:145.
- Rolain JM, Lepidi H, Harlé JR, et al. Acute acalculous cholecystitis associated with Q fever: report of seven cases and review of the literature. Eur J Clin Microbiol Infect Dis 2003; 22:222.
- Million M, Walter G, Bardin N, et al. Immunoglobulin G anticardiolipin antibodies and progression to Q fever endocarditis. Clin Infect Dis 2013; 57:57.
- Fournier PE, Casalta JP, Piquet P, et al. Coxiella burnetii infection of aneurysms or vascular grafts: report of seven cases and review. Clin Infect Dis 1998; 26:116.
- Angelakis E, Edouard S, Lafranchi MA, et al. Emergence of Q fever arthritis in France. J Clin Microbiol 2014; 52:1064.
- Million M, Raoult D. Recent advances in the study of Q fever epidemiology, diagnosis and management. J Infect 2015; 71 Suppl 1:S2.
- Kampschreur LM, Wegdam-Blans MC, Wever PC, et al. Chronic Q fever diagnosis— consensus guideline versus expert opinion. Emerg Infect Dis 2015; 21:1183.
- Botelho-Nevers E, Fournier PE, Richet H, et al. Coxiella burnetii infection of aortic aneurysms or vascular grafts: report of 30 new cases and evaluation of outcome. Eur J Clin Microbiol Infect Dis 2007; 26:635.
- Million M, Bellevegue L, Labussiere AS, et al. Culture-negative prosthetic joint arthritis related to Coxiella burnetii. Am J Med 2014; 127:786.e7.
- Raoult D, Fenollar F, Stein A. Q fever during pregnancy: diagnosis, treatment, and follow-up. Arch Intern Med 2002; 162:701.
- Carcopino X, Raoult D, Bretelle F, et al. Managing Q fever during pregnancy: the benefits of long-term cotrimoxazole therapy. Clin Infect Dis 2007; 45:548.
- www.cdc.gov/ncidod/dvrd/qfever/index.htm#prevention1 (Accessed on March 03, 2006).
- Nielsen SY, Mølbak K, Henriksen TB, et al. Adverse pregnancy outcomes and Coxiella burnetii antibodies in pregnant women, Denmark. Emerg Infect Dis 2014; 20:925.
- Million M, Roblot F, Carles D, et al. Reevaluation of the risk of fetal death and malformation after Q Fever. Clin Infect Dis 2014; 59:256.
- Stein A, Raoult D. Q fever during pregnancy: a public health problem in southern France. Clin Infect Dis 1998; 27:592.
- Vaidya VM, Malik SV, Kaur S, et al. Comparison of PCR, immunofluorescence assay, and pathogen isolation for diagnosis of q fever in humans with spontaneous abortions. J Clin Microbiol 2008; 46:2038.
- Anderson A, Bijlmer H, Fournier PE, et al. Diagnosis and management of Q fever--United States, 2013: recommendations from CDC and the Q Fever Working Group. MMWR Recomm Rep 2013; 62:1.
- Fournier PE, Raoult D. Comparison of PCR and serology assays for early diagnosis of acute Q fever. J Clin Microbiol 2003; 41:5094.
- Hogema BM, Slot E, Molier M, et al. Coxiella burnetii infection among blood donors during the 2009 Q-fever outbreak in The Netherlands. Transfusion 2012; 52:144.
- Fenollar F, Fournier PE, Raoult D. Molecular detection of Coxiella burnetii in the sera of patients with Q fever endocarditis or vascular infection. J Clin Microbiol 2004; 42:4919.
- Singh S, Kowalczewska M, Edouard S, et al. Cell extract-containing medium for culture of intracellular fastidious bacteria. J Clin Microbiol 2013; 51:2599.
- Omsland A, Cockrell DC, Howe D, et al. Host cell-free growth of the Q fever bacterium Coxiella burnetii. Proc Natl Acad Sci U S A 2009; 106:4430.
- Chieng D, Janssen J, Benson S, et al. 18-FDG PET/ CT Scan in the Diagnosis and Follow-up of Chronic Q fever Aortic Valve Endocarditis. Heart Lung Circ 2016; 25:e17.
- Wang SX, Zhang XC, Wang SY, et al. (18)F-FDG PET/CT localized valvular infection in chronic Q fever endocarditis. J Nucl Cardiol 2015; 22:1320.
- Rolain JM, Gouriet F, Brouqui P, et al. Concomitant or consecutive infection with Coxiella burnetii and tickborne diseases. Clin Infect Dis 2005; 40:82.
- Maurin M, Raoult D. Q fever. Clin Microbiol Rev 1999; 12:518.
- CLINICAL MANIFESTATIONS
- Acute infection
- - Flu-like illness
- - Pneumonia
- - Hepatitis
- - Acute endocarditis
- - Additional manifestations
- - Laboratory findings
- Persistent localized infection
- - Chronic endocarditis
- - Vascular infection
- - Bone and joint infection
- - Other forms of persistent infection
- Q FEVER IN PREGNANCY
- APPROACH TO DIAGNOSIS
- When to suspect Q fever
- Diagnosis of acute infection
- Diagnosis of persistent localized infection
- DIAGNOSTIC METHODS
- Polymerase chain reaction
- Radiographic imaging
- DIFFERENTIAL DIAGNOSIS
- POST-Q FEVER FATIGUE SYNDROME
- SUMMARY AND RECOMMENDATIONS