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Q Fever

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Physician’s Guide to Terrorist Attack

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Abstract

Q fever, short for Query fever, is a zoonotic disease caused by infection with Coxiella burnetii, an obligate intracellular Gram-negative bacterium of low virulence but remarkable infectivity and persistence. Distributed globally, inhalation of as little as a single rickettsia-like organism may initiate infection. In addition, a spore-like form of the organism is extremely resistant to heat, desiccation, and many standard antiseptic compounds, thus allowing C. burneii to persist in the environment for weeks to months. Thus, animals or humans are usually infected indirectly from inhalation of spores in a contaminated environment, such as after parturition of an infected animal. In contrast to its marked infectivity, acute infection may be asymptomatic or relatively benign, causing a transient, incapacitating febrile illness but rare fatalities. Therefore, it is considered a low-to-moderate risk agent for bioterrorist attack.

The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as representing the opinion of the Department of the Army, the Department of the Air Force, or the Department of Defense.

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References

  1. Report of WHO Consultants. Health Aspects of Chemical and Biological Weapons. World Health Organization, Geneva, 1970.

    Google Scholar 

  2. Smart JK. History of chemical and biological warfare: an American perspective. In: Sidell FR, Takafuji ET, Franz DR, eds. Textbook of Military Medicine: Medical Aspects of Chemical and Biological Warfare. Borden Institute, Washington, DC, 1997, pp. 9–86.

    Google Scholar 

  3. Department of the Army. U.S. Army Activity in the U.S. Biological Warfare Programs. Vol. II. Publication DTIC B19342TL. Headqquarters, Department of the Army. Washington DC, 1977, Annendix 4

    Google Scholar 

  4. Derrick EH. “Q” fever, new fever entity: clinical features, diagnosis and laboratory investigation. Med J Aust 1937;2:281–299.

    Google Scholar 

  5. Burnet FM, Freeman M. Experimental studies on the virus of Q fever. Med J Aust 1937;2:299–302.

    Google Scholar 

  6. Cox HR, Bell EJ. The cultivation of Rickettsia diaporica in tissue culture and in the tissues of developing chick embryos. Public Health Rep 1939:54:2171–2175.

    Article  Google Scholar 

  7. Dyer RE. A filter-passing infectious agent isolated from ticks: IV. Human infection. Public Health Rep 1938:53:2277–2283.

    Google Scholar 

  8. Maurin M, Raoult D. Q fever. Clin Microbiol Rev 1999;12:518–553.

    CAS  Google Scholar 

  9. Heinzen RA, Stiegler GL, Whiting LL, Schmitt SA, Mallavia LP, Frazier ME. Use of pulsed field gel electrophoresis to differentiate Coxiella burnetii strains. Ann NY Acad Sci 1990;590:504–513

    Article  PubMed  CAS  Google Scholar 

  10. Thiele D, Willems H, Kopf G, Krauss H. Polymorphism in DNA restriction patterns of Coxiella burnetii isolates investigated by pulsed field gel electrophoresis and image analysis. Eur J Epidemiol 1993:9:419–425.

    Article  PubMed  CAS  Google Scholar 

  11. Jager C, Willems H, Theile D, et al. Molecular characterization of Coxiella burnetii isolates. Epidemiol Infect 1998;120:157–164.

    Article  PubMed  CAS  Google Scholar 

  12. Willems H, Jager C, Balger G. Physical and genetic map of the obligate intracellular bacterium Coxiella burnetii. J Bacteriol 1998;180:3816–3822.

    PubMed  CAS  Google Scholar 

  13. Savinelli EA, Mallavia LP. Comparison of Coxiella burnetii plasmids to homologous chromosomal sequences present in a plasmid-less endocarditis-causing isolate. Ann NY Acad Sci 1990;590:523–533.

    Article  PubMed  CAS  Google Scholar 

  14. Samuel JE, Frazier ME, Mallavia LP. Correlation of plasmid type and disease caused by Coxiella burnetii. Infect Immun 1985;49:775–779.

    PubMed  CAS  Google Scholar 

  15. Valkova D, Kazar J. A new plasmid (QpDV) common to Coxiella burnetii isolates associated with acute and chronic Q fever. FEMS Microbiol Lett 1995;125:275–280.

    Article  PubMed  CAS  Google Scholar 

  16. Hackstadt K. Antigenic variation in phase I lipopolysaccharide of Coxiella burnetii isolates. Infect Immun 1986;52:337–340.

    PubMed  CAS  Google Scholar 

  17. Toman R, Skultety L. Structural study on a lipopolysaccharide from Coxiella burnetii strain Nine Mile in avirulent phase II. Carbohydr Res 1996;283:175–185.

    Article  PubMed  CAS  Google Scholar 

  18. Amano KI, Williams JC. Chemical and immunological characterization of lipopolysaccharides of phase I and phase II Coxiella burnetii. J Bacteriol 1984;160:994–1002.

    PubMed  CAS  Google Scholar 

  19. Heinzen RA, Hackstadt T, Samuel JE. Developmental biology of Coxiella burnetii. Trends Microbiol 1999;7:149–154.

    Article  PubMed  CAS  Google Scholar 

  20. McCaul TF, Williams JC. Developmental cycle of Coxiella burnetii: structure and morphogenesis of vegetative and sporogenic differentiations. J Bacteriol 1981;147:1063–1076.

    PubMed  CAS  Google Scholar 

  21. Wiebe ME, Burton PR, Shankel DM. Isolation and characterization of two cell types of Coxiella burnetii phase I. J Bacteriol 1972;110:368–377.

    PubMed  CAS  Google Scholar 

  22. Babudieri B. Q fever: a zoonosis. Adv Vet Sci 1959;5:81–182.

    Google Scholar 

  23. Huebner RJ, Bell JA. Q fever studies in southern California: summary of current results and a discussion of possible control measures. JAMA 1951;145:301–305.

    Article  CAS  Google Scholar 

  24. Lang GH. Coxiellosis (Q fever) in animals. In: Marrie TJ, ed. Q Fever, vol I. The Disease. CRC Press, Boca Raton, FL, 1990.

    Google Scholar 

  25. Langley JM, Marre TJ, Covert A, Waag DM, Williams JC. Poker players’ pneumonia: an urban outbreak of Q fever following exposure to a parturient cat. N Engl J Med 1988;319:354–356.

    Article  PubMed  CAS  Google Scholar 

  26. Dupuis G, Petite J, Vouilloz M. An important outbreak of human Q fever in a Swiss alpine valley. Int J Epidemiol 1987;16:282–287.

    Article  PubMed  CAS  Google Scholar 

  27. Fishbein DB, Raoult D. A cluster of Coxiella burnetii infections associated with exposure to vaccinated goats and their unpasteurized dairy products. Am J Trop Med Hyg 1992;47:35–40.

    PubMed  CAS  Google Scholar 

  28. Boschini A, Di Perri G, Legnani D. Consecutive epidemics of Q fever in a residential facility for drug abusers: impact on persons with human immunodeficiency virus infection. Clin Infect Dis 1999;28:866–872.

    Article  PubMed  CAS  Google Scholar 

  29. Tissot-Dupont H, Raoult D, Brouqui P, et al. Epidemiologic features and clinical presentation of acute 0 fever in hospitalized patients-323 French cases. Am J Med 1992; 93:427–434.

    Article  PubMed  CAS  Google Scholar 

  30. Raoult D, Levy PY, Tissot-Dupont H, et al. Q fever and HIV infection. AIDS 1993;7:81–86.

    Article  PubMed  CAS  Google Scholar 

  31. Tigrett WD, Benenson AS. Studies on Q fever in man. Trans Assoc Am Physicians 1956;69:98–104.

    Google Scholar 

  32. Raoult D, Stein A. Q fever during pregnancy-a risk for women, fetuses and obstetricians. N Engl J Med 1994;330:371.

    Article  Google Scholar 

  33. Milazzo A, Hall R, Storm PA. et al. Sexually transmitted Q fever. Clin Infect Dis 2001;33:399–402.

    Article  PubMed  CAS  Google Scholar 

  34. Humphres RC, Hinrichs DJ. Role of antibody in Coxiella burnetii infection. Infect Immun 1981;31:641–645.

    PubMed  CAS  Google Scholar 

  35. Byrne, WR. Q fever. In: Sidell FR, Takafuji ET, Franz DR, eds. Medical Aspects of Chemical and Biological Warfare. Office of the Surgeon General, U.S. Army, Washington DC, 1997, pp. 523–537.

    Google Scholar 

  36. Syrucek L, Sobeslovsky 0, Gutvirth I. Isolation of Coxiella burnetii from human placentas. J Hyg Epidemiol Microbiol Immunol 1958;2:29–35.

    PubMed  CAS  Google Scholar 

  37. Raoult D, Brouqui P, Marchon B, Gastaut JA. Acute and chronic Q fever in patients with cancer. Clin Infect Dis 1992;14:127–130.

    Article  PubMed  CAS  Google Scholar 

  38. Raoult D, Raza A, Marrie TJ. Q fever endocarditis and other forms of chronic Q fever. In: Manie TJ, ed. Q Fever, vol I. The Disease. CRC Press, Boca Raton, FL, 1990, pp. 179–199.

    Google Scholar 

  39. Mege JL, Maurin M, Capo C, Raoult D. Coxiella burnetii: the query fever bacterium. A model of immune subversion by a strictly intracellular organism. FEMS Microbiol Rev 1997;19:209–217.

    Article  PubMed  CAS  Google Scholar 

  40. Koster FT, Williams JC, Goodwin JS. Cellular immunity in Q fever: specific lymphocyte unresponsiveness in 0 fever endocarditis. J Infect Dis 1985;152:1283–1289.

    Article  PubMed  CAS  Google Scholar 

  41. Brouqui P, Dumler JS, Raoult D. Immunohistologic demonstration of Coxiella burnetii in the valves of patients with Q fever endocarditis. Am J Med 1994;97:451–458.

    Article  PubMed  CAS  Google Scholar 

  42. Derrick EH. The course of infection with Coxiella burnetii. Med J Aust 1973;1:1051–1057.

    PubMed  CAS  Google Scholar 

  43. Smith DL, Ayres JG, Blair I, et al. A large Q fever outbreak in the West Midlands: clinical aspects. Respir Med 1993;87:509–517.

    Article  PubMed  CAS  Google Scholar 

  44. Bernit E, Pouget J, Janbon F, et al. Neurological involvement in acute Q fever: a report of 29 cases and review of the literature. Arch Intern Med 2002;162:693–700.

    Article  PubMed  Google Scholar 

  45. Marrie TJ. Coxiella burnetii (Q fever) pneumonia. Clin Infect Dis 1995;26(suppl 3):S253–S264.

    Article  Google Scholar 

  46. Manie TJ. Liver involvement in acute Q fever. Chest 1988;94:896–898.

    Google Scholar 

  47. Levy P, Raoult D, Razongles JJ. Q fever and autoimmunity. Eur J Epidemiol 1989;5:447–453.

    Article  PubMed  CAS  Google Scholar 

  48. Stein A, Raoult D. Q fever during pregnancy: a public health problem in southern France. Clin Infect Dis 1998;27:592–596.

    Article  PubMed  CAS  Google Scholar 

  49. Fournier PE, Casalta JP, Habib G, Messana T, Raoult D. Modification of the diagnostic criteria proposed by the Duke endocarditis service to permit improved diagnosis of Q fever endocarditis. Am J Med 1996;100:629–633.

    Article  PubMed  CAS  Google Scholar 

  50. Brouqui P, Tissot-Dupont H, Drancourt M, et al. Epidemiologic and clinical features of chronic Q fever: 92 cases from France (1982–1990). Arch Intern Med 1993:153:642–648.

    Article  PubMed  CAS  Google Scholar 

  51. Ayres JG, Flint N, Smith EG, et al. Post-infection fatigue syndrome following Q fever. Q J Med 1998;91:105–123.

    Article  CAS  Google Scholar 

  52. U.S. Department of Health and Human Services. Biosafety in Microbiological and Biomedical Laboratories, 4th ed. U.S. Government Printing Office, Washington, DC, 1999, pp. 148–149.

    Google Scholar 

  53. Fournier PE, Marre TJ, Raoult D. Diagnosis of Q fever. J Clin Microbiol 1998;36: 1823–1834.

    PubMed  CAS  Google Scholar 

  54. Raoult D, Torres H, Drancourt M. Shell-vial assay: evaluation of a new technique for determining antibiotic susceptibility, tested in 13 isolates of Coxiella burnetii. Antimicrob Agents Chemother 1991;35:2070–2077.

    Article  PubMed  CAS  Google Scholar 

  55. Musso D, Raoult D. Coxiella burnetii blood cultures from acute and chronic Q fever patients. J Clin Microbiol 1995;33:3129–3132.

    PubMed  CAS  Google Scholar 

  56. Stein A, Raoult D. Detection of Coxiella burnetii by DNA amplification using the polymerase chain reaction. J Clin Microbiol 1992;30:2462–2466.

    PubMed  CAS  Google Scholar 

  57. McDonald R, Cao T, Borschel R. Multiplexing for the detection of multiple biowarfare agents shows promise in the field. Mil Med 2001;166:237–239.

    PubMed  CAS  Google Scholar 

  58. Tissot-Dupont H, Thirion X, Raoult D. Q fever serology: cutoff determination for microimmunofluorescence. Clin Diagn Lab Immunol 1994;1:189–196.

    Google Scholar 

  59. Peter O, Dupuis G, Peacock MG, Burgdorfer W. Comparison of enzyme-linked immunosorbent assay and complement fixation and indirect fluorescent-antibody tests for detection of Coxiella burnetii antibody. J Clin Microbiol 1987;25:1063–1067.

    PubMed  CAS  Google Scholar 

  60. Waag D, Chulay J, Manie TJ, England M, Williams JC. Validation of an enzyme immunoassay for serodiagnosis of acute Q fever. Eur J Clin Microbiol Infect Dis 1995;14:421–427.

    Article  PubMed  CAS  Google Scholar 

  61. Field PR, Mitchell JL, Santiago A, et al. Comparison of a commercial enzyme-linked immunosorbent assay with immunofluorescence and complement fixation tests for detection of Coxiella burnetii (Q fever) immunoglobulin M. J Clin Microbiol 2000;38: 1645–1647.

    PubMed  CAS  Google Scholar 

  62. Devine P, Doyle C, Lambkin G. Combined determination of Coxiella burnetii-specific immunoglobulin M (IgM) and IgA improves specificity in the diagnosis of acute Q fever. Clin Diagn Lab Immunol 1997;4:384–386.

    PubMed  CAS  Google Scholar 

  63. Maurin M, Benoliel AM, Bongrand P, Raoult D. Phagolysosomal alkanization and the bactericidal effects of antibiotics: the Coxiella burnetii paradigm. J Infect Dis 1992;166:1097–1102.

    Article  PubMed  CAS  Google Scholar 

  64. Raoult D. Treatment of Q fever. Antimicrob Agents Chemother 1993;37:1733–1736.

    Article  PubMed  CAS  Google Scholar 

  65. Rolain JM, Maurin M, Raoult D. Bacteriostatic and bactericidal activities of moxifloxacin against Coxiella burnetii. Antimicrob Agents Chemother 2001;45:301–302.

    Article  PubMed  CAS  Google Scholar 

  66. Gikas A, Kofteridis DP, Manios A, et al. Newer macrolides as empiric treatment for acute Q fever infections. Antimicrob Agents Chemother 2001;45:3644–3646.

    Article  PubMed  CAS  Google Scholar 

  67. Yeaman MR, Baca OG. Unexpected antibiotic susceptibility of a chronic isolate of Coxiella burnetii. Ann NY Acad Sci 1990;590:297–305

    Article  PubMed  CAS  Google Scholar 

  68. Brezina R, Schramek S, Kazar J. Selection of chlortetracycline-resistant strain of Coxiella burnetii. Acta Virol 1975;19:496.

    PubMed  CAS  Google Scholar 

  69. Powell OW, Kennedy KP, McIver M, Silverstone H. Tetracycline in the treatment of Q fever. Aust Ann Med 1962:11:184–188.

    PubMed  CAS  Google Scholar 

  70. Spelman DW. Q fever: a study of 111 consecutive cases. Med J Aust 1982;1:547–553.

    PubMed  CAS  Google Scholar 

  71. Bertrand A, Janbon F, Jonquet O, Reynes J. Infections par les rickettsiales et fluoroquinolones. Pathol Biol (Paris) 1988;36:493–495.

    CAS  Google Scholar 

  72. Raoult D, Marrie TJ. Q fever. Clin Infect Dis 1995;20:489–496.

    Article  PubMed  CAS  Google Scholar 

  73. Levy PY, Drancourt M, Etienne J, et al. Comparison of different antibiotic regimens for therapy of 32 cases of Q fever endocarditis. Antimicrob Agents Chemother 1991;35:533–537.

    Article  PubMed  CAS  Google Scholar 

  74. Raoult D, Houpikian P, Tissot-Dupont H, Riss JM, Arditi-Djiane J, Brouqui P. Treatment of Q fever endocarditis: comparison of 2 regimens containing doxycycline and ofloxacin or hydroxychloroquine. Arch Intern Med 1999;159:167–173.

    Article  PubMed  CAS  Google Scholar 

  75. Weber DJ, Rutala WA. Risks and prevention of nosocomial transmission of rare zoonotic diseases. Clin Infect Dis 2001;32:446–456.

    Article  PubMed  CAS  Google Scholar 

  76. Fenollar F, Fournier PE, Carrieri MP, et al. Risk factors and prevention of Q fever endocarditis. Clin Infect Dis 2001;33:312–316.

    Article  PubMed  CAS  Google Scholar 

  77. Izzo A, Marmion BP, Worswick DA. Markers of cell-mediated immunity after vaccination with an inactivated, whole-cell Q fever vaccine. J Infect Dis 1988;157:781–789.

    Article  PubMed  CAS  Google Scholar 

  78. Luoto L, Bell FJ, Casey M, Lackman DB. Q fever vaccination of human volunteers. 1. Serologic and skin test response following subcutaneous injection. Am J Hyg 1963;78:1–15.

    PubMed  CAS  Google Scholar 

  79. Ormsbee RA, Bell EJ, Lackman DB, Tallent G. The influence of phase on the protective potency of Q fever vaccine. J Immunol 1964;92:404–412.

    PubMed  CAS  Google Scholar 

  80. Williams JC, Peacock MG, Waag DM, et al. Vaccines against coxiellosis and Q fever. Development of a chloroform-methanol residue subunit of phase I Coxiella burnetii for the immunization of animals. Ann NY Acad Sci 1992;653:88–111.

    Article  PubMed  CAS  Google Scholar 

  81. Waag DM, England MJ, Pitt NLM. Comparative efficacy of a Coxiella burnetii chloroform methanol residue (CMR) vaccine and a licensed cellular vaccine (Q-Vax) in rodents challenged by aerosol. Vaccine 1994;15:1779–1783.

    Article  Google Scholar 

  82. Ormsbee RA, Marmion BP. Prevention of Coxiella burnetii infection: vaccines and guidelines for those at risk. In: Marrie TJ, ed. Q Fever, vol I. The Disease. CRC Press, Boca Raton, FL, 1990, pp. 225–248.

    Google Scholar 

  83. Schmeer N, Muller P, Langel J, Krauss H, Frost JW, Wieda J. Q fever vaccines for animals. Zentralbl Bakteriol Microbiol Hyg 1987;267:79–88.

    CAS  Google Scholar 

  84. Ackland JA, Worswick DA, Marmion BP. Vaccine prophylaxis of Q fever: a follow-up study of the efficacy of Q-Vax (CSL) 1985–1990. Med J Aust 1994;160: 704–708.

    PubMed  CAS  Google Scholar 

  85. Marmion BP, Ormsbee RA, Kyrkou M, et al. Vaccine prophylaxis of abattoir-associated Q fever. Lancet 1984;ii:1411–1414.

    Article  Google Scholar 

  86. Marmion BP, Ormsbee RA, Kyrkou M, et al. Vaccine prophylaxis of abattoir-associated Q fever: eight years’ experience in Australian abattoirs. Epidemiol Infect 1990;104:275–287.

    Article  PubMed  CAS  Google Scholar 

  87. Gilroy N, Formica N, Beers M, et al. Abattoir-associated Q fever: a Q fever outbreak during a Q fever vaccination program. Aust NZ J Public Health 2001;25:362–367.

    Article  CAS  Google Scholar 

  88. Williams JC, Damrow TA, Waag DM, Amano KI. Characterization of a phase I Coxiella burnetii chloroform-methanol residue vaccine that induces active immunity against Q fever in C57BL/10ScN mice. Infect Immun 1986;51:851–858.

    PubMed  CAS  Google Scholar 

  89. Fries LF, Waag DM, Williams JC. Safety and immunogenicity in human volunteers of a chloroformmethanol residue vaccine for Q fever. Infect Immun 1993;61:1251–1258.

    PubMed  CAS  Google Scholar 

  90. Kazar J, Brezina R, Palanova A, Turda B, Schramek S. Immunogenicity and reactogenicity of a Q fever chemovaccine in persons professionally exposed to Q fever in Czechoslovakia. Bull WHO 1982;60:389–394.

    PubMed  CAS  Google Scholar 

  91. Kortepeter M, ed. USAMRIID’ s Medical Management of Biological Casualties Handbook, 4th ed. U.S. Army Research Institute of Infectious Diseases, Fort Detrick, MD, 2001.

    Google Scholar 

  92. Rotz LD, Khan AS, Lillibridge SR, et al. Public health assessment of potential biologic terrorism agents. Emerg Infect Dis 2002;8:225–230.

    Article  PubMed  Google Scholar 

  93. Scott GH, Williams JC. Susceptibility of Coxiella burnetii to chemical disinfectants. Ann NY Acad Sci 1990;590:291–296.

    Article  PubMed  CAS  Google Scholar 

  94. Raoult D, Tissot-Dupont H, Foucault C, et al. Q fever 1985–1998. Clinical and epidemiologic features of 1,383 infections. Medicine (Baltimore) 2000;79:109–123.

    Article  CAS  Google Scholar 

  95. Marrie TJ, ed. Q Fever, vol I. The Disease. CRC Press, Boca Raton, FL, 1990.

    Google Scholar 

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  1. R. Scott Miller MD
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Editors and Affiliations

  1. Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA

    Michael J. Roy MD, MPH, FACP

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Miller, R.S. (2004). Q Fever. In: Roy, M.J. (eds) Physician’s Guide to Terrorist Attack. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-663-8_9

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