Q-fever Coxiella Burnetii Dr. Hani Masaadeh MD PhD

ORGANISM Coxiella burnetii is a small pleomorphic Gram- negative bacterium that originally was classified among the Rickettsiaceae. C. burnetii proliferates intracellularly in an acidic vacuole (phagolysosome). The organism can survive for a long time as a spore in very unfavourable conditions.

Q fever is a zoonotic disease caused by Coxiella burnetii Signs and Symptoms in Humans Q fever begin with sudden onset of one or more of the following: high fevers, severe headache, general malaise, myalgia, confusion, sore throat, chills, sweats, non- productive cough, nausea, vomiting, diarrhea, abdominal pain, and chest pain.malaisemyalgia

Q-fever: Coxiella burnetii Obligate intracellular rickettsia Highly infectious - one organism may cause disease Found worldwide Reservoir = animals Hardy organism

Q-fever: Reservoir Species Goats, sheep and cattle: No obvious illness in animals Can cause abortions Cats Rabbits Birds Rodents ????

Q-fever: Transmission to Humans Organism is excreted in urine, feces, milk, and especially in birth fluids Humans are usually infected by inhalation of the organism from contaminated environments Occasionally raw milk

Potential Sources of Infection Contaminated wool Soiled laundry Livestock trucks Livestock Air conditioner ducts in common with animal quarters Contaminated airborne dust particles

Q-fever High concentrations in animal tissues, especially placenta Survives for long periods in environment Highly resistant to physical and chemical agents

Q-fever: Risk Factors Direct contact with infected animals Farmers Veterinarians Slaughterhouse workers Sheep researchers

Q Fever: Human Illness Incubation period is 20 days ( days) Symptoms may include headache, weakness, malaise, chills, severe sweats, retro-orbital pain Pneumonia Abnormal liver function tests Granulomatous hepatitis

Q Fever: Human Illness Self-limited febrile illness of 2-14 days Chronic Q fever endocarditis results in less than 1% of Q fever cases Endocarditis may develop in 1 to several years after infection Osteomyelitis and/or neurologic manifestations are also possible

TREATMENT The aim of treatment is different in acute and chronic Q fever. In acute infection, bacteriostatic treatment will usually suffice for a clinical cure. Doxycycline is a good choice here. In chronic Q fever treatment with doxycycline, ciprofloxacin and rifampicin should preferably be given for a long period (1-3 years).

Preventive Measures Education of high risk individuals restrict access to birthing areas disposal of birth products Pasteurization of milk Currently, no commercially available vaccine in the United States Surveillance in researchers who work with sheep

TAKE HOME Zoonoses are common Non-specific symptoms Diagnostic tests difficult to interpret Ask about risk factors