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Q Fever

Q Fever

Diagnosis

1.
Fever, diaphoresis, cough and pleuritic chest pain

2.
Resembles viral illness or other types of atypical pneumonia

3.
Mild hepatitis may occur; endocarditis may be chronic

4.
Confirmed by serology (complement fixation, enzyme immunoassay or immunofluorescence)
History

1.
Described in Australia as “Query fever”

2.
Cause found in 1937
Pathophysiology

1.
Zoonotic dz caused by rickettsia, Coxiella burnetii (intracellular, gram negative coccobacillus)

2.
Inhalation of aerosols contaminated with organisms

3.
Farmers and slaughterhouse workers at risk

4.
Cattle, goats, sheep are natural reservoirs

5.
Infective dose: 1-100 organisms

6.
Incubation: 14-39 d

7.
Duration: wks

8.
Lethality: moderate if untreated

9.
Persists for mnths on wood & sand
Prevention

1.
Vaccine: IND 610 0.5 ml SQ; investigational

2.
PEP: tetracycline 500 mg qid within 8-12 d of exposure x 5 d OR doxycycline x 5 d if symptomatic
Isolation/Decontamination

1.
Standard precautions for healthcare workers

2.
Remove all contaminated clothing

3.
Soap and water or after 30 minute contact time with 5% hydrogen peroxide or 70% ethyl alcohol
Treatment (acute)

1.
Tetracycline 500 mg q6h OR doxycycline 100 mg PO q12h for 2-3 wks until pt is afebrile for 1 wk

2.
Alt: ofloxacin 200 mg PO q12h OR perfloxcin 400 mg IV or PO q12h for 2-3 wks until pt is afebrile for 1 wk

3.
Child >8 yo: tetracycline 25 mg/kg/d in divided doses for 2-3 wks

4.
For granulomatous hepatitis: prednisone PO 0.5 mg/kg/d if fever persists following antibiotics; taper over 1 mth
Disposition

1.
Self-limited illness even without treatment

* Material is taken from the PEPID database
* Copyrighted material – All Rights Reserved
* For more information visit http://www.pepid.com

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