eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Q Fever: Follow-up

Author: Alexandre F Migala, DO, Staff Physician, Department of Emergency Medicine, Denton Regional Medical Center
Coauthor(s): Leah Neumann, LP, Licensed Paramedic, Williamson County Emergency Serves, Georgetown, Texas
Contributor Information and Disclosures

Updated: Oct 16, 2007

Follow-up

Further Outpatient Care

  • Although not a reportable condition, physicians may consider notifying public health officials, depending on circumstances and potential risk of others developing Q fever.
  • Follow up with primary care provider to confirm complete recovery.
  • Patients with endocarditis or a history of valvular disease may require referral to a cardiologist or cardiothoracic surgeon for possible valve replacement.
  • Because of the risk of chronic infection, clinical and serologic follow-up for 2 years is recommended, particularly in individuals at risk.

Deterrence/Prevention

  • A commercial human Q fever vaccine (Q-Vax) is manufactured in Australia but is not available in the United States. An investigational vaccine is only available in the United States after consultation with the US Army Medical Research Institute of Infectious Diseases (USAMRIID) (Official mailing address: Commander USAMRIID, Attn: MCMR-UIZ-R, 1425 Porter Street, Frederick, MD 21702-5011).
  • Maintain appropriate precautions during periods of potential exposure, particularly around parturient and farm animals.
  • Take proper precautions to reduce possible tick exposure, including using permethrin, diethyltoluamide (DEET), and other repellents (see Tick-borne Diseases, Introduction).
  • Avoid consumption of unpasteurized milk or milk products.
  • Use only seronegative sheep in research facilities.
  • Postexposure prophylaxis for 5 days by using tetracycline or doxycycline is effective if initiated within 8-12 days of exposure. Treatment with tetracycline during the incubation period may delay but not prevent the onset of symptoms.
  • Isolation and decontamination with standard precautions are recommended for healthcare workers because person-to-person transmission is rare. Decontamination is accomplished with soap and water or after a 30-minute contact time with 5% quaternary ammonium compound (MicroChem plus; MicroChem, Newton, MA), 5% hydrogen peroxide, or 70% ethyl alcohol.

Complications

  • Meningoencephalitis
  • Endocarditis
  • Acute respiratory distress syndrome
  • Increased rate of abortions

Prognosis

  • Patients with acute Q fever have an excellent prognosis. The mortality rate is less than 1%, and morbidity is minimal with appropriate therapy.
  • Chronic Q fever requires prolonged antimicrobial therapy. Untreated endocarditis is almost universally fatal, though the mortality rate decreases to less than 10% with appropriate treatment. The overall mortality rate remains 10-25%.

Patient Education

  • Patient education focuses primarily on issues of avoidance and deterrence.
    • Avoid unpasteurized milk and dairy products.
    • Take precautions to avoid tick bites.
    • Avoid parturient animals.
    • Minimize occupational exposure.
  • For excellent patient education resources, visit eMedicine's Bites and Stings Center. Also, see eMedicine's patient education article Ticks.

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider the diagnosis eliminates any possibility of making the diagnosis
  • Failure to maintain an adequate level of clinical suspicion reduces the already poor detection rate for Q fever
  • Failure to maintain an epidemiologic approach with any cluster of clinical presentations, particularly atypical pneumonia or hepatitis
 


More on Q Fever

Overview: Q Fever
Differential Diagnoses & Workup: Q Fever
Treatment & Medication: Q Fever
Follow-up: Q Fever
References
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References

  1. Marrie TJ, Stein A, Janigan D, Raoult D. Route of infection determines the clinical manifestations of acute Q fever. J Infect Dis. Feb 1996;173(2):484-7. [Medline].

  2. Marrie TJ. Coxiela Burnetti (Q Fever). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Disease. 4th ed. New York, NY: Churchill Livingstone; 1995:1727-35.

  3. Raoult D, Tissot-Dupont H, Foucault C, et al. Q fever 1985-1998. Clinical and epidemiologic features of 1,383 infections. Medicine (Baltimore). Mar 2000;79(2):109-23. [Medline].

  4. Dupuis G, Petite J, Peter O, Vouilloz M. An important outbreak of human Q fever in a Swiss Alpine valley. Int J Epidemiol. Jun 1987;16(2):282-7. [Medline].

  5. Raoult D, Houpikian P, Tissot Dupont H, et al. Treatment of Q fever endocarditis: comparison of 2 regimens containing doxycycline and ofloxacin or hydroxychloroquine. Arch Intern Med. Jan 25 1999;159(2):167-73. [Medline].

  6. Healy B, Llewelyn M, Westmoreland D, Lloyd G, Brown N. The value of follow-up after acute Q fever infection. J Infect. Apr 2006;52(4):e109-12. [Medline].

  7. Bartlett JG. Questions about Q fever. Medicine (Baltimore). Mar 2000;79(2):124-5. [Medline].

  8. Caron F, Meurice JC, Ingrand P, et al. Acute Q fever pneumonia: a review of 80 hospitalized patients. Chest. Sep 1998;114(3):808-13. [Medline].

  9. Casolin A. Q fever in New South Wales Department of Agriculture workers. J Occup Environ Med. Apr 1999;41(4):273-8. [Medline].

  10. Cutler SJ; Bouzid M; Cutler RR. Q fever. J Infect. APR-2007;54(4):313-8. [Medline].

  11. Daya M, Nakamura Y. Pulmonary Disease from Biological Agents: Anthrax, Plague, Q Fever, and Tularemia. Critical Care Clinics. 2005;21:747-763. [Medline].

  12. Ellis ME, Smith CC, Moffat MA. Chronic or fatal Q-fever infection: a review of 16 patients seen in North-East Scotland (1967-80). Q J Med. Winter 1983;52(205):54-66. [Medline].

  13. Fergusson RJ, Shaw TR, Kitchin AH, et al. Subclinical chronic Q fever. Q J Med. Oct 1985;57(222):669-76. [Medline].

  14. Maurin M, Raoult D. Q fever. Clin Microbiol Rev. Oct 1999;12(4):518-53. [Medline].

  15. Osterbauer PJ, Dobbs MR. Neurobiological weapons. Neurol Clin. May 2005;23(2):599-621. [Medline].

  16. Raoult D, Marrie TJ, Mege JL. Natural history and pathophysiology of Q fever. The Lancet Infectious Diseases. 2005;5:219-226. [Medline].

  17. Sawyer LA, Fishbein DB, McDade JE. Q fever: current concepts. Rev Infect Dis. Sep-Oct 1987;9(5):935-46. [Medline].

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Further Reading

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Keywords

Q fever, Rickettsia, Coxiella burnetii, C burnetii, Rickettsiaceae, Q fever endocarditis, hepatitis, pneumonia, acute Q fever, myocarditis, pericarditis, chronic Q fever, osteomyelitis, septic arthritis, hepatomegaly, jaundice

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Contributor Information and Disclosures

Author

Alexandre F Migala, DO, Staff Physician, Department of Emergency Medicine, Denton Regional Medical Center
Alexandre F Migala, DO is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Osteopathic Association, Association of Military Osteopathic Physicians and Surgeons, and Texas Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Leah Neumann, LP, Licensed Paramedic, Williamson County Emergency Serves, Georgetown, Texas
Disclosure: Nothing to disclose.

Medical Editor

José Rafael Romero, MD, Director of Pediatric Infectious Diseases Fellowship Program, Associate Professor, Department of Pediatrics, Combined Division of Pediatric Infectious Diseases, Creighton University/University of Nebraska Medical Center
José Rafael Romero, MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, New York Academy of Sciences, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc
Disclosure: Nothing to disclose.

Managing Editor

Leslie L Barton, MD, Professor, Program Director, Department of Pediatrics, University of Arizona School of Medicine
Leslie L Barton, MD is a member of the following medical societies: American Academy of Pediatrics, Association of Pediatric Program Directors, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

CME Editor

Robert W Tolan Jr, MD, Chief of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Consulting; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching; sanofi pasteur Grant/research funds Unrestricted research grant; sanofi pasteur  Consulting; sanofi pasteur Honoraria Speaking and teaching; Tap Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD, Professor and Vice Chairman, Department of Pediatrics, Head, Division of Infectious Diseases, Louisiana State University Health Sciences Center
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
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