What is appendicitis?

Appendicitis is due to inflammation and infection of the appendix, which, as a result, becomes swollen and can rupture (burst).

Appendicitis should never be treated lightly, as a severe infection and possible rupturing of the appendix can inflame and infect the whole of the abdominal wall (peritonitis) and have very serious and life-threatening consequences.

The appendix is a small, tubular appendage that is about 9cm which is attached at the cecum, the start of the colon (large intestine).

Facts about appendicitis

• The appendix is part of the lymphatic system and contains lymphatic tissue
• During adolescence, the appendix has an important role in maturing B cells, the white blood cells which are also known as lymphocytes and also in producing the antibody immunoglobulin A (IgA)
• In the unborn foetus, the appendix contains endocrine cells that make hormones and other substances necessary for development
• Appendicitis mostly occurs in children and young adults aged between 10 – 30 years
• Appendicitis is rare in young children, especially in those under 2 years
• Appendicitis is the most common emergency abdominal surgery for children and younger adults

Symptoms of appendicitis

Chronic appendicitis

Symptoms of chronic appendicitis include:

• Abdominal pain – this is normally the first (and sometimes main) symptom
• Diarrhoea
• Loss of appetite
• Low grade fever
• Nausea
• Swelling of the abdomen
• Vomiting

Acute appendicitis

Acute appendicitis occurs when the appendix is severely infected and inflamed and as a result of this, ruptures (or bursts). If this occurs, the the faecal matter in the appendix can contaminate the abdominal cavity and cause peritonitis.

Peritonitis is a very serious and life-threatening situation and needs urgent medical attention. Call an ambulance 000.

The symptoms of acute appendicitis are the same as chronic appendicitis, just more severe.

Anyone who experiences progressively worsening abdominal pain needs to seek urgent medical attention.

Causes of appendicitis

While it is not known definitively what exactly causes appendicitis, a few theories have been proposed.

Infection

One possible cause of appendicitis is a recent infection in some part of the digestive system (stomach or small intestine) and the virus or bacteria from this infection then travels to the appendix and infects it too, so that it becomes inflamed and infected. Another possibility is an infection from another part of the body that travels to the appendix and infects it too.

Obstruction

Another possible cause of appendicitis is the theory that some faeces could get stuck in the appendix and this can cause it to get inflamed, irritated and infected when the bacteria that are inside the faeces multiply within the small confines of the appendix. In addition to faeces, other theories for obstruction include parasites and certain growths that can also occur within the appendix and cause the same inflammation and infection.

Inflammatory Bowel Disease

Another theory proposed is that inflammatory bowel disease (such as Crohn’s disease and ulcerative colitis) can cause inflammation of the bowels and possibility of obstruction and abscess of any part of the bowel (including the appendix). This is linked to a low fibre diet.

Injury to the bowel

If the bowel (colon) experiences an injury or trauma in some way, at the point where the appendix sits, this could cause the appendix to become inflamed and irritated.

Prevention of appendicitis

Non-preventable risk factors

Appendicitis may be unpreventable in certain circumstances:

• Age – children and young adults are more likely to experience appendicitis, with the risk factor highest in those who are aged between 10-30. The reason for this is not known
• Infection – a recent infection, especially if it occurs in the gastrointestinal system is a known risk factor for increasing likelihood of infection of the appendix and subsequent appendicitis
• Injury – any injury to the abdominal area near the appendix has the potential to cause it to be inflamed and likely to rupture, if the trauma is severe enough
• Recent infection – it is well known that the risk for appendicitis, especially in children and younger adults, can be much higher after a recent infection in the digestive system (or other part of the body) which travels to the appendix to cause it to be infected and inflamed
• Trauma to the appendix – if the appendix has been injured in some way (through an accident of some sort that causes internal injuries), this can also increase risk for appendicitis where the appendix becomes very inflamed and swollen and risk for rupture also increases

Preventable risk factors

There are some medical experts who think that proper digestion is a possible way to prevent appendicitis (especially the mild form) from occurring.

• Low fibre diet – a low fibre diet is linked to many digestive disorders that can increase risk of appendicitis. A low fibre diet especially increases risk for constipation and this can cause some of the faecal matter to become lodged in the appendix and cause appendicitis. A healthy diet, rich in fibre from vegetables, fruit, wholegrains and legumes is vital for a healthy digestive system and to prevent various digestive disorders. Studies show that people whose diet is high in fibre have lower incidence of appendicitis
• Obstruction – an obstruction in the bowel (colon) or improper working bowel can lead to obstruction in the appendix. If the faecal matter does not move past the appendix, it can get stuck in it. Obstruction is generally linked to a poor diet, which is low in fibre, although some cases of obstruction may not be caused by poor diet

Complications of appendicitis

The main complication of appendicitis is when very inflamed and infected appendix ruptures (or bursts). If this occurs, the the faecal matter in the appendix can contaminate the abdominal cavity and cause peritonitis.

Peritonitis is a very serious and life-threatening situation and needs urgent medical attention. Call an ambulance 000.

If there are complications, (the appendix bursts, or other things go wrong during surgery), the patient will be advised to stay in hospital longer to rule out any subsequent infections.

People who have any of the symptoms of appendicitis need to seek medical attention to get a medical diagnosis to rule out appendicitis, as it can be fatal if it is acute and is not promptly treated.

When to see a doctor about appendicitis

A doctor should be consulted if any of the symptoms of appendicitis occur, especially if the pain is unabating and severe.

Appendicitis can be potentially life threatening (if the appendix ruptures), so always seek emergency treatment if there are symptoms of appendicitis.

Diagnosis of appendicitis

Appendicitis has such similar symptoms to other conditions affecting the abdominal organs, it can be a challenge to diagnose it.

To confirm appendicitis (or rule it out), the doctor will perform the following initial tests:

• Medical history – the doctor will ask some questions about the onset of symptoms, the type of symptoms and where the pain emanates from in the stomach area
• Physical examination – the doctor will examine the abdomen for pain and tenderness, particularly from where the pains originate
• Observation – if the symptoms are not too severe (or they dissipate), the doctor may recommend observation to determine if the pain returns or improves

Other tests

In addition to the initial tests, the following tests can also be performed:

• Blood test – a blood test can determine if there is an infection in the body, which can be identified if the white blood cell numbers are elevated
• Urine test – this is a simple test to help rule out conditions such as a bladder and kidney infections or urinary tract infections (UTIs), which can present with the same symptoms
• CT scan – this is sometimes performed to have a closer look at the appendix, to see if it is inflamed and swollen, which is an indication of infection (but this is not usually performed in an emergency situation where surgery is the only option after examination)

Conventional treatment of appendicitis

There are a few approaches to treating appendicitis, depending on severity and duration of symptoms.

Observation

If the symptoms are not too severe (or they dissipate), the doctor may recommend observation to determine if the pain returns or improves. Observation is mostly done at hospital, where emergency treatment (surgery) can be performed if symptoms increase dramatically and/or the appendix ruptures.

Medication

If the appendicitis is mild and is determined to be caused by an infection, the following medications can be prescribed:

• Antibiotics – the doctor may prescribe antibiotics to reduce the bacterial infection which is the source of the appendicitis
• Pain killers – the doctor may prescribe over-the-counter (or prescription) pain killing medication to reduce the severity of the pain

Surgery

If it is determined that it is appendicitis and especially if the appendix is very inflamed or infected and has the potential to rupture, then the doctor may decide to remove the appendix as a precautionary measure (to prevent possible complications of a ruptured appendix).

There are two types of surgery that can be performed, depending on a number of factors:

• Laparoscopic appendectomy – this is a newer type of surgery for removal of an appendix, which is known as keyhole surgery, as it enables the surgeon to make smaller incisions in the abdomen in which a thin tube with a camera and light are inserted. This allows the surgeon to view the appendix (and surrounding tissue) and remove it. A laparoscopic appendectomy requires less time in hospital for recovery (only a few days), leaves less scarring and is the preferable surgery for removing an infected appendix
• Traditional appendectomy – a traditional appendectomy requires a larger incision (cut) in the abdomen, leaves a bigger scar and requires a stay of up to a week in hospital to recuperate from the surgery. This type of surgery is usually recommended in the following circumstances:
  • the appendix has burst and an emergency procedure is required
  • women who are in their first trimester of pregnancy
  • people who have had any type of previous abdominal surgery, especially if it has been performed more than once
  • people who have existing tumours in their digestive system

Whatever type of surgery is performed, it may still take up to a few weeks to completely heal from the surgery after leaving hospital.

Alternative / complementary treatment of appendicitis

Appendicitis can be a serious and potentially life-threatening condition which requires urgent medical attention for diagnosis and treatment.

Do not try to treat suspected appendicitis with any alternative / complementary therapy – seek urgent medical advice

The information contained within this section is to be used only in cases of very mild appendicitis or to support healing after an appendectomy. Always seek medical advice to ensure it is safe to take these supplements.

Herbs

• Aloe vera – the cold pressed juice of the whole leaf of the aloe vera plant, has a number of beneficial properties for the gastrointestinal system, including limiting “bad” bacteria in the colon, increasing conditions for “good” bacteria, reducing risk of infection and improving colon health in general
• Echinacea purpurea – this herb has immune enhancing properties for the whole of the immune system. Echinacea has anti-viral, anti-bacterial and anti-fungal properties, which means it may be able to prevent infection by these pathogens
• Slippery elm (Ulmus fulva) – the herb slippery elm has mucilaginous properties, which means it coats the gastrointestinal tract with its soothing properties and relieves any inflammation. Some studies suggest that slippery elm may also contain some antioxidants, which help to boost the function of the immune system. People with any type of bowel blockage need to seek medical advice prior to trying slippery elm, as it could make their condition worse

Vitamins

• Betacarotene – the antioxidant vitamin betacarotene greatly enhances immunity and protects against further infection
• Vitamin A – the potent antioxidant vitamin A supports the immune system and protects against further infection
• Vitamin B – a vitamin B complex is recommended as it supports the immune system, supports the function of the antioxidant vitamins and helps the body absorb nutrients more effectively
• Vitamin C – the potent antioxidant vitamin C helps to boost the function of the immune system and helps to protect the body against infection. Vitamin C also helps to detoxify the system by allowing them to be removed through the liver
• Vitamin E – the potent antioxidant vitamin E helps to greatly boost the function of the immune system and white blood cells. Vitamin E promotes healing of all body tissues and cells

Minerals

• Zinc – the mineral zinc is an excellent antioxidant which greatly boosts the immune system and promotes healing of all body tissues and cells to occur more quickly

Other supplements

• Chlorophyll – this is the substance which gives plants their green colouring and also makes food for the plant. Chlorophyll may assist with clearing the blood of toxins and may help speed up healing. Try to get chlorophyll in its liquid form, as it is more effective

Dietary modifications

• Add more fibre – fibre is necessary in our diet, to help the colon function more effectively. Many studies show that people who have a fibre-rich diet have less incidence of appendicitis
• Reduce processed foods – food which is natural and unprocessed tends to be more richer in nutrients, have higher levels of fibre and is better for you

Lifestyle modifications

There are no lifestyle modifications recommended for appendicitis.

Alternative treatments

There are no other alternative treatments recommended for appendicitis.

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 appendicitis

If the appendicitis is mild, there are a few strategies that can be used to reduce symptoms and prevent further inflammation:

• High fibre diet – studies show that a diet high in fibre greatly reduce risk of appendicitis from occurring in the first place. A diet high in fibre includes plenty of vegetables (especially leafy green vegetables), fruits, legumes, wholegrains and cereals. Adults need to ensure they get about 30g of fibre in their diet every day

Post-operative care after surgery

If the appendicitis requires surgery, then post operative care may require the following strategies to aid recovery:

• Diet – the surgeon will recommend a special diet for 1-2 weeks after the surgery to make it easier on the gastrointestinal system to digest food after the surgery, in order to assist in the healing the colon from where the appendix was removed
• Medication – the surgeon may also recommend some medication to take to prevent possibility of infection after the surgery (antibiotics) and also painkillers for any pain that may ensue
• Rest – in order for the abdominal wall incision to heal (especially if it is was from a traditional appendectomy) rest is recommended with no lifting for some time after the surgery (up to two weeks, but the surgeon will recommend a timeframe based on the severity of symptoms, the surgery and how serious it was)

Caring for someone with appendicitis

Parents

If your child has appendicitis, you can care for them through the following strategies:

• Healthy diet – in general, ensure your child has a diet which is rich in fibre and unprocessed foods to try to reduce risk of appendicitis occurring in the first place. A healthy diet includes a number of servings of vegetables, fruit, legumes, wholegrains, fish, protein and healthy fats
• Take them to the doctor – if a child experiences any abdominal pain, always seek medical advice from a family doctor. If the pain is very severe and the child has severe symptoms of suspected appendicitis, call an ambulance on 000
• Recuperation from surgery – if your child undergoes surgery, especially an emergency appendectomy, they will need to spend some weeks after the surgery healing. Your doctor will recommend a specific course of action for post-operative care, including medication and activity levels
• Inform the school – in addition to your care post surgery, you will also need to inform you child’s school so that they can provide an amount of school work at the doctors directions so that the child does not fall behind in their studies

Partner

If your partner has appendicitis, you can support them with the following strategies:

• Healthy diet – in general, ensure both you and your partner have a diet which is rich in fibre and unprocessed foods to try to reduce risk of appendicitis occurring in the first place. A healthy diet includes a number of servings of vegetables, fruit, legumes, wholegrains, fish, protein and healthy fats
• Take them to the doctor – if your partner experiences any abdominal pain, always seek medical advice from a family doctor. If the pain is very severe and your partner has severe symptoms of suspected appendicitis, call an ambulance on 000
• Recuperation from surgery – if your partner undergoes surgery, especially an emergency appendectomy, they will need to spend some weeks after the surgery healing. Your doctor will recommend a specific course of action for post-operative care, including medication and activity levels

Friends

If you have a friend who has appendicitis, you can support them with the following strategies:

• Support – if your friend’s appendicitis needs any type of surgery to remove the appendix, your friend will need to recuperate after surgery for some time (up to a few weeks), so it would be very supportive to visit them after the surgery

References

Last reviewed and updated: 14 May 2024

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

• Carcopino X, Raoult D, Bretelle F, Boubli L, Stein A. Managing Q fever during pregnancy: the benefits of long-term cotrimoxazole therapy. Clin Infect Dis. 2007 Sep 1;45(5):548-55. Epub 2007 Jul 17
• Chiu CK, Durrheim DN. A review of the efficacy of human Q fever vaccine registered in Australia. NSW Public Health Bulletin. 2007 Jul-Aug; 18 (7-8):133-6
• Cone LA, Curry N, Shaver P, Brooks D, DeForge J, Potts BE. Q fever in the Southern California desert: epidemiology, clinical presentation and treatment. Am J Trop Med Hyg. 2006 Jul;75(1):29-32
• Delsing CE, Kullberg BJ. Q fever in the Netherlands: a concise overview and implications of the largest ongoing outbreak. Neth J Med. 2008 Oct;66(9):365-7
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Last reviewed and updated: 14 May 2024

What is anaemia?

Anaemia (also written anemia) is a condition in which the number of red blood cells (RBCs) is lowered or if there is a reduction in the level of haemoglobin in the blood.

If a person has anaemia, oxygen transportation around the body is impaired and the person becomes under-oxygenated are tires easily.

There are a few different types of anaemia:

• Aplastic anaemia – this type of anaemia is characterised by a failure of the bone marrow to produce red and white blood cells and platelets
• Haemolytic anaemia – this type of anaemia is characterised by the body destroying red blood cells faster than new ones can be produced, which can result from a range of autoimmune disorders and even from some medications
• Iron deficiency anaemia – this type of anaemia is characterised by a lack of iron, so that there is also a lack of haemoglobin – this is the most common type of anaemia
• Megaloblastic anaemia – this type of anaemia is caused by a deficiency of folic acid in the diet not enough leafy green vegetables), which makes the red blood cells become abnormally big and unable to perform their functions properly
• Pernicious anaemia – this type of anaemia is characterised by a lack of Vitamin B12 inhibiting the correct formation of red blood cells
• Sick cell anaemia – this is type of anaemia is characterised by the haemoglobin being in the abnormal shape of a sickle, instead of being healthy and round in shape

Facts about anaemia

• Severe anaemia, such as that resulting from a life-threatening injury, needs to be immediately treated by a blood transfusion
• Some types of anaemia are caused by congenital defects in the body (sickle cell and aplastic anaemia) require monitoring all through life to prevent serious ill health
• Anaemia literally means “without blood”
• While iron deficiency is the most common reason for the occurrence of anaemia, it is not the only type of anaemia

Symptoms of anaemia

General symptoms of anaemia

• Breathlessness on exertion
• Chronically tired or fatigued – this is the main symptom as there is not enough oxygen flowing to the cells of the body
• Easily bruising
• Feeling faint or dizzy
• Inability to concentrate
• Pallor (paleness of skin and looking sickly)

Further symptoms of anaemia

• Loss of sex drive
• Nervousness
• Palpitations
• Shortness of breath
• Slow healing
• Sweating
• Thirst
• Weak and fast pulse

Causes of anaemia

The most common causes of anaemia are due to:

• Deficient or abnormal haemoglobin content in the red blood cells
• Diet low in iron, folic acid or vitamin B12
• Heavy menstrual bleeding
• Lack of iron stores
• Lowered level of red blood cells

Less common reasons for anaemia are:

• Abnormally shaped red blood cells
• Blood diseases, such as leukemia
• Chronic renal (kidney) failure
• Endocrine disorders (such as low thyroid activity)
• Infections, such as from malaria

Prevention of anaemia

Some types of anaemia are unable to be prevented and should be managed with medical advice:

Non-preventable risk factors

Research shows that there are some risk factors associated with the development of anaemia that are mainly unable to be prevented:

• Age – people over 65 are more likely to have anaemia than younger people. Research shows that 40-60% of people in nursing homes who are over 85 years are more likely to have anaemia. Researchers think this is due to the gastrointestinal system not functioning as well as it did before
• Aplastic anaemia – there is no way to prevent this type of anaemia as the cause is not known. Aplastic anaemia occurs when the bone marrow fails to produce red and white blood cells and platelets
• Auto-immune problems – certain types of anaemia are thought to be caused by an auto-immune problem and current science does not know how these types of anaemia are triggered nor how to cure them (examples are, aplastic anaemia, haemolytic anaemia)
• Cancer – people with some types of cancer may becomes more at risk of developing anaemia, so blood tests should be done on a regular basis to prevent it
• Genetics – certain types of anaemia have a genetic basis, which means certain people are more liable to have this type of anaemia especially if other family members also have it too (for example, sickle cell anaemia)
• Haemolytic anaemia – this type of anaemia occurs when the red blood cells get destroyed more quickly than they can be replaced, through an autoimmune response by the body
• Heavy menstrual periods – women who have heavy blood losses each month may become more easily anaemic as their reserves of iron (and possibly haemoglobin) become quickly depleted each month and replacement may not happen rapidly enough
• Lack of folic acid – people who do not get adequate levels of folic acid in their diet (either by not eating enough foods rich in folic acid, or having a gastrointestinal disorder which prevents absorption of folic acid from food eaten), may develop anaemia
• Lack of iron – people who do not get adequate levels of iron in their diet (either by not eating enough foods rich in iron, or having a gastrointestinal disorder which prevents absorption of iron from food eaten), may develop anaemia
• Lack of vitamin B12 – people who do not get adequate levels of vitamin B12 in their diet (either by not eating enough foods rich in vitamin B12, having a gastrointestinal disorder which prevents absorption of vitamin B12 from food eaten or having a problem with intrinsic factor), may develop this type of anaemia (pernicious anaemia). Vegetarians are usually most at risk of pernicious anaemia because they may not be eating foods rich in vitamin B12
• People with stomach ulcers – these people may be at risk of anaemia if the stomach ulcer bleeds internally and this causes significant blood loss that may not be able to be replaced adequately
• Pernicious anaemia – this type of anaemia can occur when the body does not produce enough intrinsic factor in the intestines and this prevents the vitamin B12 (cyanocobalamin) from being properly absorbed. Pernicious anaemia causes the red blood cells to become large and improperly formed so that they cannot function properly. This type of anaemia can also occur when there is not enough intake of vitamin B12 (cyanocobalamin) in the diet, which can cause a deficiency
• Pregnancy – research shows that women who are pregnant have a higher risk for developing anaemia due to a nutritional deficiency. This is because the unborn child requires a lot of nutrients as does the mother to help nourish the unborn child and because the amount of blood circulating in the pregnant mother increases, which means more iron and haemoglobin are required
• Sick cell anaemia – this is a genetic disorder which causes the red blood cells to be formed in the shape of a sickle (similar to the crescent of the moon), which cannot function properly

Preventable risk factors

Some types of anaemia are generally easier to prevent through proper intake of certain foods rich in these nutrients in the diet:

• Folic acid deficiency anaemia – this type of anaemia can generally occur when there is too little folic acid in the diet which causes a deficiency and ultimately causes the red blood cells to become abnormally large and unable to function properly
• Iron deficiency anaemia – this type of anaemia can occur when there is not enough iron intake in the diet, which can cause a deficiency and ultimately causes a lack of haemoglobin, the molecule responsible for oxygen transportation throughout the blood

Complications of anaemia

There are a number of complications of anaemia, which if can cause health problems if the anaemia is left undiagnosed and is severe:

• Infections – people with the anaemia are more susceptible to getting infections from viruses and bacteria and have a harder time fighting them off
• Severe bleeding – if bleeding is severe, internal and excessive (from an accident) then death can ensue if a blood transfusion is not given and the cause of the bleeding is not treated
• Stroke – if haemoglobin is defective, it can damage the walls of the red blood vessels and this can result in narrowing or even blockages in the brain, which can lead to serious, life threatening strokes (especially in children)

Untreated anaemia can cause a number of symptoms, which while not generally life threatening, can disrupt the quality of life.

People with any of the symptoms for anaemia should make an appointment to see their doctor to be diagnosed and promptly treated.

When to see a doctor about anaemia

A doctor should be consulted if symptoms of anaemia start to occur. It is much more preferable to see a doctor as soon as symptoms start to reduce discomfort and to prevent symptoms from getting worse.

The information on the alternative-complementary treatment of anaemia should be looked at to determine if any of the simple suggestions there provide a resolution for for symptoms, especially if the anaemia has already been diagnosed as a nutrient deficiency.

A doctor will usually suggest the simple options first for anaemia.

Diagnosis of anaemia

Anaemia is normally diagnosed (confirmed) by the following:

• Medical history of symptoms – your doctor will take a complete history of duration, severity and onset of symptoms
• Blood test – a blood test will confirm if anaemia is present and can usually detect the type of anaemia too. The blood test normally includes a full blood count (of both red and white blood cells and platelets), levels of iron and haemoglobin

Further blood tests

If the first blood test cannot confirm anaemia, further blood tests may be ordered to test for other types of anaemia caused by lack of certain nutrients, such as vitamin B12 and folic acid in general.

Once anaemia is diagnosed and confirmed, then your doctor will advise on treatment options.

Conventional treatment of anaemia

Conventional treatment that is recommended for anaemia depends on the cause and the severity of the anaemia.

Blood transfusion

If the anaemia is really bad due to severe blood loss (injury, accident) and blood levels are too low, then a blood transfusion will be given to prevent death.

Oxygen therapy

Some people with severe anaemia (usually due to injury, illness or accident ) may require an oxygen mask to help them breath, if their oxygen levels are too low. This is due to a lack of of haemoglobin in the blood, which carries around the oxygen to the cells. Oxygen therapy is usually given in hospital and only used for patients with very severe anaemia.

Supplements

If the anaemia is due to a deficiency of particular nutrients, then the most common form of treatment are supplement (given in a variety of formats, depending on the type of anaemia):

• Iron injections – the mineral iron can be given by injection for people who have very low blood levels of this mineral, but in general an iron supplement is recommended for most people with low iron levels
• Vitamin B12 injections – people who cannot make enough intrinsic factor in their stomach or have very low levels of vitamin B12 will be given regular vitamin B12 injections to treat their pernicious anaemia
• Vitamin and mineral supplements – these are given when there is a general deficiency of a number of nutrients to top them up and avoid worsening of symptoms

Surgery

Some people may need surgery to stop the cause of their anaemia:

• Hysterectomy – this surgery involves partial or full removal of the uterus and ovaries and is often performed on women who are past their child bearing years and who have excessive bleeding
• Spleenectomy – this surgery involves removal of the spleen in cases of severe haemolytic anaemia

Alternative / complementary treatment of anaemia

Anyone who thinks they may have anaemia needs to have a proper diagnosis by their doctor to ensure they are getting proper treatment and use this information in conjunction and with approval of medical advice.

The following are the treatments advocated by alternative therapists:

Herbs

There are no herbs which are recommended to help treat anaemia.

Vitamins

There are a number of vitamins which are beneficial in preventing nutritional-deficiency anaemia and others which support blood function:

• B vitamin complex – a B vitamin complex is necessary to help ensure the proper function of the blood vessels and haemoglobin
• Folic acid – if a blood test confirms that folic acid levels are low, supplementation will be required to bring folic acid levels back to normal and treat the anaemia
• Vitamin B12 – pernicious anaemia is due to a deficiency of vitamin B12, so this may require injections of vitamin B12 to avoid the stomach (as intrinsic factor may also not be functioning properly)
• Vitamin C – the antioxidant vitamin C is useful to help the body absorb more of the iron and vitamin B12 in food, it also helps to enhance haemoglobin function and it also ensures folic acid is used more effectively by the body
• Vitamin E – the antioxidant vitamin E is beneficial in conjunction with vitamin C to help the body use the haemoglobin more effectively and prevent it from becoming unhealthy. Vitamin E also helps the blood becomes less sticky and may prevent stroke (which is a complication of sickle cell anaemia)

Minerals

There are a number of minerals which are beneficial in preventing nutritional-deficiency anaemia and others which support blood function:

• Iron – when blood iron levels are low, this can cause iron-deficiency anaemia, so supplementation will be required. The best forms of absorbable iron are: iron chelate, ferrous gluconate, fumarate or phosphate. Iron supplementation should not self-prescribed, but only taken when iron-deficiency anaemia has been diagnosed, as too high levels of iron can cause toxicity

Other nutrients

There are some other nutrients which are recommended to help with certain types of anaemia:

• Probiotics – such as acidophilus can help the intestinal flora become more balanced with “good” bacteria and assist with absorption of vitamin B12

Dietary modifications

For people who have been diagnosed with nutritional deficiencies, the following are recommended:

• Increase foods rich in folic acid – people who are low in this important vitamin need to increase their intake of foods rich in folic acid, such as spinach, kale, collard greens (any dark green, leafy vegetables)
• Increase foods rich in iron – people who have been diagnosed with iron deficiency anaemia need to increase their intake of foods rich in iron, such as kidneys, liver, egg yolk
• Increase foods rich in vitamin B12 – people who have been diagnosed with vitamin B12 deficiency anaemia need to increase their intake of foods rich in vitamin B12, such as mollusks, beef liver, trout, salmon
• Increase foods rich in vitamin C – people with any type of nutritional deficiency anaemia should include foods rich in vitamin C, to help their body better absorb those nutrients and reduce anaemia symptoms

Lifestyle modifications

There are no lifestyle modifications which are recommend for people with anaemia.

Alternative treatments

There are no other alternative treatments which are recommended for people with anaemia.

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 anaemia

Management of people with anaemia requires the following:

• Medication – take the medications that have been prescribed to prevent worsening of symptoms or any complications that may arise
• Reduce nutritional deficiencies – people need to eat a varied diet to ensure they have enough of all the vitamins and minerals especially and avoid anaemia due to a deficiency of nutrients
• Regular blood tests – people who have already been diagnosed with anaemia and feel the symptoms returning again, should have regular blood tests to ensure their anaemia is not longer affecting them
• Reduce doctor visits – people who have anaemia that is due to a genetic problem or auto-immune dysfunction need to see their doctor regularly to manage their condition, which while not curable, can often be managed successfully to try to ensure some good quality of life

Caring for someone with anaemia

Partner

People with a partner who has any type of anaemia can help to support their partner with the following strategies:

• Injections – a partner is often called upon to give any vitamin B12 injections that the person with anaemia may need

Friends

People with a friend who has any type of anaemia can help to support their friend with the following strategies:

• Support – just providing a good level of support and understanding for a friend with anaemia is helpful. If your friend is not always be available for social outings due to ill health, it is always good to be understanding

Parents

Parents who have a child that has any type of anaemia can help to support their child with the following strategies:

• Good diet – growing children require a varied diet with enough fresh food to help them grow healthy and strong, so ensure they have plenty of vegetables, fruit, grains, legumes and protein foods
• Regular doctor visits – children with any type of anaemia need to visit their doctor regularly to monitor their condition, especially if the anaemia is due to a genetic disorder or auto-immune problem
• Supplementation – a doctor will recommend supplementation if it is required and parents can try to monitor it so that supplements are taken regularly

References

Last reviewed and updated: 14 May 2024