Q fever

What is Q fever

Q fever is a serious infection which is caused by a bacteria (Coxiella burnetii). This bacteria is found in infected animals and is then passed onto humans, who are similarly infected.

People can be infected by the bacteria that causes Q fever by unintentionally inhaling tiny droplets of the infected bacteria when bodily fluids such as faeces, urine and birth material especially are excreted by an infected animal.

Q fever can be either one of the following types:

• Acute Q fever– sudden and severe onset of symptoms after exposure to the bacteria Coxiella burnetii
• Chronic Q fever – this develops in people who have been infected with the bacteria Coxiella burnetii for over 6 months without effective treatment

Both acute and chronic Q fever can cause death if the bacteria proliferates too quickly and medication is not prescribed quickly enough. The incidence of death due to Q fever is about 1-2% of all reported cases of the condition.

Facts about Q fever

• Q fever can adversely affect the lungs, liver, heart especially, but it can also affect other tissues and organs of the body
• There is a vaccine available for Q fever which has been developed in Australia and it is advised for people who are at the highest risk of coming into contact with animals infected with this disease
• People working in the livestock industry with cattle and livestock industry are at the highest risk of developing this condition
• People with Q fever should register their condition, to prevent it spreading and to help monitor their condition
• Q fever has been reported all over the world
• Q fever was first discovered in abattoir workers in Queensland (Australia) in the 1930’s
• The “Q” in Q fever means “query” as scientists at the time were querying the reason for the disease – they didn’t know what caused it
• Coxiella burnetii is a highly infectious disease that is quite resistant to heat and which can become airborne and inhaled by humans
• Approximately 1% of all people who develop Q fever will also have a complication such as chronic endocarditis, a serious inflammation of the heart muscle

Symptoms of Q fever

Symptoms of Q fever do not usual present until after an incubation period of about 20 days from exposure to the bacteria. Only about half of all people infected with the bacteria that causes Q fever ever show any symptoms.

Symptoms of acute Q fever

• Chest pain when breathing
• Clay-colored stools
• Cough
• Fever
• Headache
• Jaundice
• Muscle pains
• Shortness of breath

Symptoms of chronic Q fever

• Chills
• Fatigue
• Night sweats
• Prolonged fever
• Shortness of breath

Causes of Q fever

Many animals can cause Q fever , especially if they have an active infection at the time.

Q fever has been found in the following animals – birds, cats, cattle, dogs, goats, rodents, sheep, ticks, which can cause Q fever in humans when it is passed through breathing in or touching infected urine, faeces, birth material and milk.

The animals that predominantly cause Q fever are:

• Cattle
• Goats
• Sheep

Prevention of Q fever

Non-preventable risk factors

Q fever may be unpreventable in certain circumstances:

• Livestock workers – people who work in the livestock industry with cattle especially are the most exposed to the Coxiella burnetii bacteria which causes Q fever, due to the nature of their work and this is very difficult to prevent, other than taking necessary precautions as advised. People at the highest risk of Q fever infection are:
  • Abattoir workers
  • Dairy workers
  • Farmers
  • Laboratory technicians who work with the organism
  • People who cull and process kangaroos
  • People who transport livestock
  • Shearer’s
  • Sheep workers
  • Veterinarians

Preventable risk factors

There are ways to prevent Q fever from occurring:

• Don’t touch animal faeces or urine – since Q fever can occur in a great many animals, not just livestock, it is advisable not to touch any animal faeces or urine with bare hands as it could be infected. The best way to prevent infection is to stay away from animal faeces and urine, but if it must be collected or removed, always use gloves and a face mask to prevent breathing in any bacteria

Complications of Q fever

There are a number of very serious complications of both acute and chronic Q fever:

• Chronic endocarditis – this health condition is serious inflammation of the heart which can be potentially fatal. Chronic endocarditis is the most common complications of Q fever, which can occur any time straight after the infection or up to four years later. While this complication is rare, it is still very serious and needs appropriate treatment
• Fatigue syndrome – many people who have Q fever are now reporting extreme fatigue and prolonged debility, which is associated with the condition chronic fatigue syndrome and which often occurs in people after a viral infection. Chronic fatigue syndrome can be very difficult to treat and symptoms can persist for years
• Hepatitis – another complication if Q fever is hepatitis, inflammation of the liver, which is a serious disease of the liver and which can be potentially fatal if not treated appropriately
• Myocarditis – a very rare complication of Q fever is myocarditis, which is an inflammation of the covering of the heart and this condition can be potentially fatal if not treated appropriately
• Pneumonia – a common complication of Q fever is a worsening of the lung infection symptoms which can result in pneumonia. This is a serious infection of the lungs which is potentially fatal if not treated appropriately

When to see a doctor about Q fever

People who have any of the symptoms of Q fever after exposure to livestock animals, especially if they work in any of the groups at risk of developing this condition, should consult with their doctor to diagnose their symptoms and either confirm Q fever or rule it out.

People with existing Q fever need to have regular check-ups with their doctor to monitor their symptoms and medication.

People with existing Q fever must consult with their doctor if they :

• Experience new symptoms or
• Experience worsening of their current symptoms

Diagnosis of Q fever

Q fever is initially diagnosed with the following tests / examinations:

• Medical history of symptoms – the doctor will ask a series of questions about your symptoms (especially the duration and severity), your family medical history (if anyone else has similar symptoms), onset of symptoms and to determine whether you are in one of the groups most at risk of developing Q fever
• Physical examination – the doctor will use a stethoscope to listen to your heart and lungs, examine various parts of your body, in order to detect the severity of the condition and symptoms

Further tests

If the doctor suspects that it could be a Q fever infection after the initial diagnosis suspects that it could be a Q fever infection, then the following test will be requested to confirm diagnosis:

• Blood test – a blood tests will be done to determine if there are are antibodies to the Coxiella burnetii bacteria. This can confirm the Q fever infection

Conventional treatment of Q fever

Conventional treatment of Q fever is dependent on whether the infection is acute or chronic.

Acute Q fever

When a person presents with acute, early symptoms of Q fever, the only treatment is the following medication:

• Antibiotics – the antibiotic doxycycline will be prescribed to kill the bacteria before the symptoms become more severe and cause possible complications

Chronic Q fever

People who have a long-standing Q fever infection, that flares up are treated with a combination of medications:

• Antibiotics – the antibiotic doxycycline will be prescribed to kill the bacteria and prevent further worsening of any symptoms and possible complications
• Anti-malarial medications – these medications are required to treat the hepatitis symptoms that often develop with this condition. The most common medications used are: hydroxychloroquine or quinolones. Chronic Q fever is much harder to treat than acute Q fever and medications may need to be taken for up to 5 years

Alternative/complementary treatment of Q fever

There is very little literature supporting alternative or complementary treatments for Q fever, but there is some evidence that a strong immune system will not be infected or infection will be mild. The following are strategies for increasing immunity and should only be undertaken with the approval and monitoring of a doctor, as q fever can be very serious and potentially life threatening.

Herbs

Studies show the following herbs all have potent anti-bacterial properties and may reduce some symptoms:

• Echinacea – studies show that the herb echinacea has both anti-viral and anti-bacterial properties, which means it may be useful in people with any type of bacterial infection such as Q fever
• Garlic – studies show that the herb garlic has excellent anti-viral and anti-bacterial properties, which means it may be useful in people with any type of bacterial infection such as Q fever
• Olive leaf – studies show that olive leaf is very useful in helping the body fight off any type of viral or bacterial infection, which means it may be useful in people with any type of bacterial infection such as Q fever

Vitamins

Certain vitamins may help reduce symptoms or even prevent this condition altogether by strengthening the immune system and reducing risk of infection:

• Betacarotene – the antioxidant betacarotene is the precursor to vitamin A, so it has the same properties as vitamin A
• Vitamin A – this antioxidant vitamin A is important to ensure the membranes lining the bronchi are healthy. Studies also show that vitamin A is important in reducing symptoms by reducing inflammation of the bronchi
• Vitamin C – studies show that vitamin C helps to reduce the incidence of respiratory infections and greatly assists with healing the lining of the bronchi, by reducing inflammation and irritation
• Vitamin E – the antioxidant vitamin E has an important role in maintaining the immune system and helps to improve symptoms and may protect against getting a bacterial or viral infection in the first place

Minerals

Certain minerals have high antioxidant content and have a protective effect on the body and enhance immunity:

• Selenium – studies show the antioxidant mineral selenium has a protective effect on the immune system by boosting its activity to fight off bacteria, which may help in any type of bacterial infection
• Zinc – studies show the antioxidant mineral zinc reduces the severity and length of symptoms of colds and flu by helping the immune system fight off the bacterial infection in the body

Other nutrients

Certain nutrients have antioxidant properties and may protect the immune system:

• Alpha-lipoic acid – the nutrient alpha-lipoic acid is a major antioxidant which helps the other antioxidants work more effectively and greatly boost their activity by enhancing the effects of the immune system to fight off any type of infection
• Cod liver oil – the potent anti-inflammatory omega-3 fatty acid cod liver oil contains high levels of naturally occurring vitamin A and vitamin D, which both help to restore mucous membranes to normal, assist with immunity and reduce severity and duration of symptoms of any type of bacterial infection
• Coenzyme Q10 – studies show that the levels of coenzyme Q10 appears to be low in people with chronic conditions of the lungs and supplementation improves symptoms by improving oxygenation in the blood to the lungs and enabling better breathing, without pain
• N-acetyl-cysteine (NAC) – studies show that NAC loosens the mucous in the lungs, making breathing easier and alleviating other symptoms associated with Q fever
• Omega 3 fatty acids – studies show the omega-3 fatty acids have potent anti-inflammatory properties that may assist with symptoms in the body in people with any type of bacterial infection such as Q fever
• Quercetin – studies show that people who eat foods high in quercetin develop less respiratory infections in general, so this means it may help to prevent an infection in the first place

Dietary modifications

The best way of enhancing the immune system is through a healthier diet:

• Drink more water – hydrating the body properly is an effective way to ensure the mucous membranes trap and expel the bacteria before it has a chance to infect the body. It is recommended to drink about 8-10 glasses of water each day (1 glass =250ml)
• Eat more fruit and vegetables – these foods have a high antioxidant content and contain many other vital nutrients especially useful for helping the body fight off any type of infection
• Eat more garlic and onions – both foods have high anti-bacterial properties and also have a protective effect on the immune system and help the body fight off any type of infection

Lifestyle modifications

Certain lifestyle factors may lower immunity and provide a more suitable environment for the bacteria to invade and infect:

• Limit alcohol intake – heavy drinking puts a great burden on the liver which is one of the organs that is infected in Q fever, in addition, heavy drinking also lowers immunity
• Rest – the body needs to be rested in order to allow it to heal more quickly from any type of infection, without the added pressure of having to deal with other bodily processes. Resting enables the body to concentrate all of the available energy to fighting the infection
• Stop smoking – the lungs can be the first organ to get infected and breathing may be difficult, so smoking only puts an added burden on the lungs and exacerbates symptoms

Alternative treatments

There are no other alternative treatments that are recommended to treat Q fever.

Always ensure that you notify your medical practitioner of any supplements that you want to take – it may interfere with other medication or conditions you have. Confirm with your doctor it is safe to take before you try it.

Living with Q fever

Self care strategies

There are a number of strategies which are recommended to help deal with Q fever:

• Adequate intake of vegetables – most vegetables have a high water content, high levels of vitamins (especially betacarotene, vitamin C and vitamin K), minerals (especially magnesium and potassium) and antioxidants which all help to reduce severity of symptoms as they have a positive effect on the function of the immune system. Dark green leafy vegetables (such as kale, spinach, watercress, tatsoi) have very high levels of nutrients most beneficial for health and may help to reduce symptoms
• Don’t smoke – the lungs are the first organ to get infected and breathing may be difficult, so smoking only puts an added burden on the lungs and exacerbates symptoms. Also do not be exposed to second-hand cigarette smoke as it has the same detrimental effects on the lungs and worsening of symptoms
• Eat more garlic, ginger and onions – studies show that both garlic and onions have anti-bacterial properties that can boost the immune system with fighting off any type of bacterial infection and may help to reduce symptoms. Ginger has proven anti-inflammatory effects as well as circulation boosting properties that may help to reduce symptoms of Q fever infection
• Keep well hydrated – ensure you drink plenty of fluids (water, diluted fruit juice and herbal tea such as chamomile, peppermint and rose hip) to keep the lungs well hydrated and help to reduce severity of symptoms. Ensuring the lungs are well hydrated helps to reduce the amount of infected thick mucous from the bronchi, which is causing the breathing difficulties
• Limit alcohol intake – heavy drinking puts a great burden on the liver, which is one of the organs that is infected in Q fever. In addition to this, heavy drinking of alcohol lowers immunity and puts extra pressure on the immune system which may be struggling to fight off the infection from q fever
• Regular doctor check-ups – ensure you visit your doctor regularly, to monitor symptoms and medication dosage. You must let your doctor know if your symptoms are getting worse or you are experiencing a worsening of symptoms to ensure you are getting the most appropriate treatment. It is also vital you consult with your doctor about alternative remedies you want to use
• Rest – the body needs to be rested in order to allow it to heal more quickly from any type of infection, without the added pressure of having to deal with other bodily processes. Resting enables the body to concentrate all of the available energy to fighting the infection

Caring for someone with Q fever

Partner

If you have a partner with Q fever, there are some useful strategies that can assist them:

• Monitor temperature – use a thermometer to monitor your partner’s temperature at regular intervals to ensure they do not have a rising fever. Seek medical attention if their body temperature rises above 40°C (104°F)
• Provide fluids – ensure that your partner is drinking adequate amounts of water, diluted fruit juice and herbal teas such as peppermint and chamomile. These types of fluids help to hydrate the body and reduce likelihood of dehydration
• Rest – ensure your partner is resting, to give their body the best chance at recovery. Resting allows the body’s energy and resources to be used to fight the infection so that it can heal

Friends

If you have a friend with Q fever, there are some useful strategies that can assist them:

• Medical attention – seek medical attention for your friend if their temperature rises above 40°C (104°F) as this indicates they have a fever

Family

If you have a family friend with Q fever, there are some useful strategies that can assist them:

• Medical attention – seek medical attention for your friend if their temperature rises above 40°C (104°F) as this indicates they have a fever

References

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Last reviewed and updated: 14 May 2024