subject: Q fever diagnosis and treatment [print this page] Q fever diagnosis and treatment
Q fever Q fever is an acute illness caused by Coxiella burnetii; itis transmitted between animals by ticks and to humansfrom domestic animals by close contact, particularly withaborted placentas or with infected carcases in abattoirs or,more often, by inhalation of the endospores, which areresistant to desiccation and persist in the environment.Q fever has a range of clinical manifestations: atypicalpneumonia, prolonged fever of undetermined cause,granulomatous hepatitis and culture-negative endocarditis.The main clinical features of acute infection are high feverwith severe headache and myalgia, after an incubationperiod of about 20 days.Hepatosplenomegaly is common, with biochemical evidenceof hepatitis and histologically granulomatous liverdisease with very well denned granulomas that can suggestthe diagnosis. Pneumonia is less common but may besevere and bilateral.Epididymo-orchitis can occur and so must be differentiatedfrom brucellosis, which also produces prolongedfever. The natural history of the disease is to resolve spontaneouslywithin 2 weeks in most patients, but a slowerrecovery with progression to chronic disease may occur.The main feature of chronic Q fever is endocarditis, whichis usually fatal if left untreated.
Diagnosis Diagnosis is usually made by serology with positive responses to the phase II antigen in acute disease, IgM andIgG, and positive serology to the phase I antigen in chronic disease, with raised IgA litres suggestive of endocarditis. Laboratory handling of the organisms is dangerous.TreatmentDoxycycline 100 mg twice daily for 14 days is the treatment of choice, but it is not known whether it prevents progression.Endocarditis is very difficult to eradicate by antibiotic therapy alone, and surgery is often required.
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