Q Fever

Q fever is an illness you get from the bacterium Coxiella burnetii (C. burnetii) that usually causes flu-like symptoms. The infection may range from mild to life-threatening.

It’s a zoonotic disease. That means it spreads between infected animals and people. It typically spreads by breathing in contaminated dust or having contact with contaminated:

• Pee
• Poop
• Milk
• Semen
• Birthing products, like amniotic fluid and placenta

Q fever isn’t common. There were about 200 cases in the U.S. in 2019. Most cases occur in Midwestern and Western states, including California, Texas and Iowa.

“Q fever” is short for query fever. It got the name query fever because healthcare providers didn’t initially know the cause. They had questions, or queries, about why people were getting sick.

Types

There are two different types of Q fever:

• Acute Q fever
• Chronic Q fever

Acute Q fever

This type causes flu-like symptoms between three and 30 days after exposure to C. burnetii. Symptoms don’t last as long.

Chronic Q fever

This type causes symptoms months or even years after a C. burnetii infection, even if you didn’t have symptoms at the time. Between 1 and 5 out of every 100 people who get a C. burnetii infection develop chronic Q fever. It can be life-threatening.

What does Q fever do to humans?

If you have symptoms, they may include:

• Feeling very tired (fatigue)
• Muscle and joint pain
• Fever
• Chills
• Headache
• Dry cough
• Stomach problems, including stomach cramps, nausea, vomiting and diarrhea
• Sweats, especially at night
• Shortness of breath
• Rash-like spots under your skin

How does someone get Q fever?

The bacterium C. burnetii causes Q fever. It mainly affects:

• Sheep
• Goats
• Cattle (cows, bulls, calves, oxen)

But it can also affect domesticated animals, like dogs, cats and rabbits. Animals can often carry it without symptoms.

The most common way that C. burnetii spreads is through breathing in contaminated dust or mist. This may happen when bodily fluids like pee, poop, milk or birthing fluids contaminate the soil. Bacteria can pretty easily travel through the air. So, you don’t have to directly interact with infected animals to get it.

Less common ways to get Q fever include:

• Eating or drinking unpasteurized dairy products, like milk, cheese or ice cream
• Tick bites

Q fever isn’t usually contagious. But there have been rare cases where it spreads from person to person, including:

• Through pregnancy or during birth
• Through a blood transfusion

Risk factors

Anyone can get Q fever. But you may be at a higher risk if you live or work near farms or spend time around farm animals. This includes:

• Veterinarians or farmers who help with animal birthing
• Slaughterhouse workers, butchers, dairy workers or other animal-processing jobs
• Researchers or lab workers

You’re at a greater risk of developing chronic Q fever if you have:

• Problems with your heart valves
• Cancer
• Chronic kidney disease (CKD)

People who receive an organ transplant are also at a high risk of chronic Q fever.

Complications

About 1 out of every 5 people who get Q fever develops Q fever fatigue syndrome (persistent Q fever). It causes you to feel very tired and have other symptoms for months or years after the infection.

If you’re pregnant and get Q fever, you’re at a higher risk of pregnancy complications and miscarriage.

C. burnetti can also infect many parts of your body. Rarer Q fever complications may include inflammation that affects your:

• Lungs
• Heart
• Brain
• Brain covering
• Liver

It can also cause a bone infection.

How doctors diagnose Q fever

A healthcare provider will:

• Review your health history
• Ask about your symptoms
• Ask if you live or work around farm animals
• Perform a physical exam

If they suspect Q fever, they’ll recommend tests to confirm their diagnosis.

Tests that are used

Healthcare providers usually recommend combining serologic testing with PCR to make an early diagnosis of Q fever.

If you have any signs of complications, they may also suggest:

• Electrocardiogram (EKG/ECG) or echocardiogram (echo) to check your heart
• Chest X-ray to look at your lungs
• Liver function tests

How is Q fever treated?

Your healthcare provider will prescribe antibiotics to treat Q fever. These may include:

• Doxycycline
• Hydroxychloroquine
• Trimethoprim-sulfamethoxazole (TMP-SMX)
• Rifampin
• Fluoroquinolones, such as ciprofloxacin or ofloxacin
• Clarithromycin

You take these as pills by mouth. Most people need to take antibiotics for up to two weeks. But you may need to take them longer if you’re at risk of serious complications. It’s very important to take all of your antibiotics as prescribed by your provider, even if you feel better. If you don’t finish your full course, Q fever may come back and be harder to treat.

If you have chronic Q fever, you may need treatment for 18 months or longer.

Recovery time

In many cases, symptoms usually last around two weeks, even without treatment. If you develop Q fever fatigue syndrome, you may feel very tired for months or years.

If you have chronic Q fever, you may have symptoms for months or years. Your healthcare provider will give you a better idea of what to expect.

When should I see my healthcare provider?

Schedule an appointment with a healthcare provider if you have Q fever symptoms, especially if you work or live around sheep, goats or cattle. Let the provider know if you’ve ever been diagnosed with Q fever in the past, even if it was a long time ago. Because there’s a risk you may develop long-term symptoms, your provider may recommend regular follow-up appointments.

During your appointment, you may want to ask questions like:

• How will you diagnose Q fever?
• Am I at risk of complications?
• Do you recommend screening for heart problems or other issues?
• What antibiotics do you recommend?
• How long do I have to take antibiotics?
• How should I store my antibiotics?
• How can I manage my symptoms at home?
• How often should I schedule follow-up appointments?

What is the prognosis for Q fever?

With proper diagnosis and treatment, the outlook is good. The mortality (death) rate is usually low, even if you don’t get treatment. But the risk of complications and death increases if it causes inflammation in your heart. Your provider will give you a better idea of what to expect.

Can Q fever be prevented?

You can help protect yourself by:

• Wearing a mask and gloves when handling animal fluids
• Avoiding unpasteurized dairy products
• Screening for heart problems if you have acute Q fever
• Getting a Q fever vaccine if you have a higher risk of Q fever (currently only available in Australia)

It’s also a good idea to talk to your healthcare provider about avoiding Q fever if you live or work around farm animals and you have a high risk of Q fever complications.