eMedicine Specialties > Emergency Medicine > Infectious Diseases

Tick-Borne Diseases, Q Fever: Follow-up

Author: Jonathan A Edlow, MD, Associate Professor of Medicine, Department of Emergency Medicine, Harvard Medical School; Associate Chief, Department of Emergency Medicine, Beth Israel Deaconess Medical Center
Contributor Information and Disclosures

Updated: Dec 9, 2008

Follow-up

Further Outpatient Care

  • Follow-up is important to ensure complete recovery.
  • If the patient's epidemiologic risk factor suggests that other people may share that risk factor (eg, an abattoir worker's coworkers and family members in a case contracted from a pregnant pet), the physician should notify the appropriate public health authorities.

Deterrence/Prevention

  • Avoid consuming unpasteurized milk and goat cheese.
  • Take proper precautions while working on a farm, and avoid exposure to parturient mammals.
  • See Tick-borne Diseases, Introduction for suggestions regarding the prevention of tick bites.

Complications

  • Acute respiratory distress syndrome
  • Thrombocytopenia
  • Endocarditis caused by chronic infection as well as infection of vascular aneurysms and prostheses
  • Spontaneous abortion and premature labor

Prognosis

  • The prognosis with acute Q fever is excellent, with a low mortality rate (about 1%) in hospitalized patients. Children usually are more mildly affected than adults.
  • Chronic Q fever has a mortality rate of about 25%.

Patient Education

  • Educate patients to avoid consumption of unpasteurized dairy products and exposure to parturient animals.
  • For excellent patient education resources, visit eMedicine's Bites and Stings Center. Also, see eMedicine's patient education article Ticks.

Miscellaneous

Medicolegal Pitfalls

  • Q fever is difficult to diagnose, primarily because physicians tend not to think of it in the differential. Consider the possibility of tick-borne illnesses in all patients with febrile illnesses. Also, exposures to animals, animal by-products, and parturient animals are risk factors.
  • In patients with a presentation consistent with hepatitis or pneumonia, Q fever must be included in the differential diagnosis. A cluster of either of these presentations should suggest Q fever.
  • The most important pitfall is failure to consider (or make) the diagnosis because the disease is so uncommon.
  • In patients with culture-negative endocarditis, consider infection with C burnetii.

Special Concerns

Since the treatment of pregnant women with Q fever is complicated and can lead to obstetric complications, infectious disease and possibly OB-GYN consultation should be considered.

 


More on Tick-Borne Diseases, Q Fever

Overview: Tick-Borne Diseases, Q Fever
Differential Diagnoses & Workup: Tick-Borne Diseases, Q Fever
Treatment & Medication: Tick-Borne Diseases, Q Fever
Follow-up: Tick-Borne Diseases, Q Fever
References
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References

  1. Scola BL. Current laboratory diagnosis of Q fever. Semin Pediatr Infect Dis. Oct 2002;13(4):257-62. [Medline].

  2. Raoult D, Fenollar F, Stein A. Q fever during pregnancy: diagnosis, treatment, and follow-up. Arch Intern Med. Mar 25 2002;162(6):701-4. [Medline].

  3. 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. Mar 25 2002;162(6):693-700. [Medline].

  4. Brouqui P, Dupont HT, Drancourt M, et al. Chronic Q fever. Ninety-two cases from France, including 27 cases without endocarditis. Arch Intern Med. Mar 8 1993;153(5):642-8. [Medline].

  5. CDC. Q fever--California, Georgia, Pennsylvania, and Tennessee, 2000-2001. MMWR Morb Mortal Wkly Rep. Oct 18 2002;51(41):924-7. [Medline].

  6. Domingo P, Munoz C, Franquet T, et al. Acute Q fever in adult patients: report on 63 sporadic cases in an urban area. Clin Infect Dis. Oct 1999;29(4):874-9. [Medline].

  7. Harris RJ, Storm PA, Lloyd A, et al. Long-term persistence of Coxiella burnetii in the host after primary Q fever. Epidemiol Infect. Jun 2000;124(3):543-9. [Medline].

  8. Madariaga MG, Rezai K, Trenholme GM, Weinstein RA. Q fever: a biological weapon in your backyard. Lancet Infect Dis. Nov 2003;3(11):709-21. [Medline].

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  10. McQuiston JH, Holman RC, McCall CL, et al. National surveillance and the epidemiology of human Q fever in the United States, 1978-2004. Am J Trop Med Hyg. Jul 2006;75(1):36-40. [Medline].

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  13. Raoult D, Marrie T, Mege J. Natural history and pathophysiology of Q fever. Lancet Infect Dis. Apr 2005;5(4):219-26. [Medline].

  14. Tissot Dupont H, Raoult D, Brouqui P, et al. Epidemiologic features and clinical presentation of acute Q fever in hospitalized patients: 323 French cases. Am J Med. Oct 1992;93(4):427-34. [Medline].

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  16. 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. Jan 15 2007;44(2):232-7. [Medline].

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Further Reading

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Keywords

Q fever, tick-borne disease, Coxiella burnetii, C burnetii, fever, vector-borne disease, tick bite, acute Q fever, chronic Q fever, febrile illness

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Contributor Information and Disclosures

Author

Jonathan A Edlow, MD, Associate Professor of Medicine, Department of Emergency Medicine, Harvard Medical School; Associate Chief, Department of Emergency Medicine, Beth Israel Deaconess Medical Center
Jonathan A Edlow, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Dan Danzl, MD, Chair, Department of Emergency Medicine, Professor, University of Louisville Hospital
Dan Danzl, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Kentucky Medical Association, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Jon Mark Hirshon, MD, MPH, Associate Professor, Department of Emergency Medicine, University of Maryland School of Medicine
Jon Mark Hirshon, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Public Health Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Charles V Pollack, Jr, MD, MA, FACEP, Professor, Department of Emergency Medicine, University of Pennsylvania College of Medicine; Chairman, Department of Emergency Medicine, Pennsylvania Hospital
Charles V Pollack, Jr, MD, MA, FACEP is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians
Disclosure: sanofi-aventis Honoraria Consulting; sanofi-aventis Honoraria Speaking and teaching; Schering-Polugh Honoraria Consulting; Schering-Plough Honoraria Speaking and teaching; The Medicines Company Honoraria Consulting; GlaxoSmithKline Grant/research funds Other

 
 
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