Q fever is a disease caused by the bacteria Coxiella burnetii which can infect various animal species such as cattle, sheep, and goats. People most at risk of infection are farmers, veterinarians, and slaughterhouse workers who are exposed through inhalation of contaminated aerosols from animal birth products. Symptoms of acute Q fever include flu-like illness with fever, nausea and headaches. Chronic Q fever can develop in about 1-5% of infected individuals and causes conditions such as endocarditis. Treatment involves doxycycline or other antibiotics. Vaccination against Q fever is available but not recommended for children under 15 or pregnant women.

1. RAMESH.KASARLA
PharmD Intern
170514883003
svcp

2. Introduction
 Q Fever is a disease caused by infection with Coxiella
burnetii.
 Coxiella burnetii Obligate intracellular, gram negative
bacterium
 Q stands for Query or Queensland
 Origin of disease unknown
 First reported cases were in Queensland, Australia
 Distributed globally
 Found in many species of animals
2

3. C. burnetii
i
en.wkipedia.org
3

4. Culture
 Grows well in yolk sac of chick embryos
and in various cell cultures .
4

5. structure
 shows phase variation .
 phase – I ,II .
 phase – I :- autoagglutinable
more immunogenic activity due to
periodate sensitive trichloracetic acid-soluble
surface carbohydrate .
o Phase – II :- more suitable for complement
fixation test (CFT) .
o both phase I ,II elicit good Ab response .
5

6. Resistance
 Resistant to physical and chemical agents
 Can survive in dust and aerosols
 Inactivated by 2% formaldehyde
5% H2O2
1% Lysol .
 Resistant to heat, drying and disinfectants
 Air samples test positive for 2+ weeks
 Soil samples test positive for 150+ days
 Spore formation
6

7. PATHOGENESIS
7

8. Primary Reservoir
Cattle Sheep
Goats
* All eukaryotes can be infected
8

9. Bacteria is excreted in:
Feces
Urine
Milk
of infected animals
9

10. Release Into Environment:-
 During birthing the organisms are shed in high
numbers in amniotic fluids and the placenta
 109 bacteria per gram of placenta
Do not touch!
10

11. Transmission
 Most common route is inhalation of aerosols
 Contaminated dust, manure, birthing products
 Tick bites (rare)
 Person-to-person (rare)
 Transplacental (congenital)
 Blood transfusions
 Bone marrow transplants
 Intradermal inoculation
 Possibly sexually transmitted
gsbs.utmb.edu
11

12. Who’s at risk?
 Farmers, veterinarians, researchers,
abattoir (slaughterhouse) workers etc.
 People who breed animals
 Immunocompromised
12

13. Phagocytosis
Binding/entry into macrophages via:
 Integrin Associated Protein (IAP)
 Leukocyte Response Integrin (LRI)
macrophage
bacteria
13

14. Lysis of phago-
lysosome and
macrophage
Phago-lysosome
fusion: bacteria
survive and
multiplies
Phagocytic vesiclePhagocytosis
Binding & Entry
14

15. *Bacteria spread through blood
gsbs.utmb.edu
Acute or Chronic Q fever
15

16. Symptoms
Acute Q fever
 Self-limiting, flu-like disease
 Fever, nausea, headaches, vomiting, chest/abdominal
pain
 Pneumonia & granulomatous hepatitis
 Other signs (< 1%)
 Myocarditis, pericarditis, meningoencephalitis
 Death: 1-2%
16

17. A: A normal
B: Q Fever pneumonia
Chest X-ray
17

18. Chronic Q fever (> 6 months)
 Endocarditis & meningoencephalitis
 Pre-existing disease
 1-5% of those infected
 Prior heart disease,
 pregnant women,
 immunocompromised
 Other
 Osteomyelitis
 Granulomatous hepatitis
 Cirrhosis
18

19. LAB DIAGNOSIS
Hard to diagnose because:
 Asymptomatic in most cases
 Looks like other disease (Flu or cold)
 Serology continues to be best method
 PCR, ELISA and other methods
 WEIL – FELIX test is negative .
 Bio safety level 3 (BSL-3) facility
19

20. Treatment
 Once infected, humans can have life-long immunity
Acute Q fever treated with:
Doxycycline (100 – 200 mg/day)
Chloramphenicol (Adult : 50 – 100 mg/kg/day
Child : 25 – 50mg/kg/day)
Erythromycin (Adult : 1-2 g/day up to 4gm/day
Child : 30 -50 mg/day up to 1g/day)
Timethoprim/sulfamethoxazole (160/800 mg)
Fluoroquinolones:-
Ciprofloxacin, Gemifloxacin,
Levofloxacin, Moxifloxacin
Norfloxacin, Ofloxacin
20

21.  For acute Q fever, doxycycline is the drug of choice,
and 2 weeks of treatment is recommended for adults,
children aged ≥8 years, and for severe infections in
patients of any age.
 Children aged < 8 years with uncomplicated acute
illness may be treated with
trimethoprim/sulfamethoxazole (160/800 mg) or a
shorter duration (5 days) of doxycycline.
 Women who are pregnant when acute Q fever is
diagnosed should be treated with
trimethoprim/sulfamethoxazole throughout the
duration of pregnancy
21

22. Chronic Q fever
 Chronic Q fever is difficult to treat, therefore a prolonged
antimicrobial regimen is recommended.
 The most current recommendation for endocarditis is
combination treatment with doxycycline and
hydroxychloroquine for at least 18 months to
eradicate any remaining C burnetii and prevent
relapses.
 An alternative option is combination of doxycycline and
a fluoroquinolone for at least 3-4 years.
22

23.  The vaccine is not recommended for children
younger than 15 years old.
 Before you are vaccinated, your doctor will perform
skin and antibody tests to see if you have been
already exposed to the infection and are immune
to it. If the tests show that you’re already immune
you will not need to be vaccinated.
 The safety of this vaccine has not been tested in
pregnant women and breastfeeding so vaccination
is not recommended.
23
Vaccine :

24.  Q-Vax Skin Test – CSL Limited (Q fever skin test). Each 0.5 mL liquid
vial when diluted to 15 mL with sodium chloride contains 16.7 ng of
purified killed suspension of C. burnetii in each diluted 0.1 mL dose;
thiomersal 0.01% w/v before dilution. Traces of formalin. May contain
egg proteins.
 Q-Vax – CSL Limited (Q fever vaccine). Each 0.5 mL pre-filled syringe
contains 25 µg purified killed suspension of Coxiella burnetii;
thiomersal 0.01% w/v. Traces of formalin. May contain egg proteins.
Side effects
 Headache is a common side effect of the Q fever vaccine that may
affect 1 to 10 in every 100 people
24

25. Prevention and Control:-
 Pasteurization and sterilization of milk and other
dairy products
 Disinfect utensils, machines used in farm areas
for birthing
 Regular testing of animals and those who work
closely with them
 Protective Personal Equipment
 Isolate new animals
25

26. Reference
 http://www.cdc.gov/qfever/
 https://en.wikipedia.org/wiki/Q_fever
 http://emedicine.medscape.com/article/227156-medication
 http://www.healthline.com/health/q-fever#Complications6
 http://www.nps.org.au/medicines/immune-system/vaccines-and-
immunisation/for-individuals/vaccines-a-z/q-fever
 Center for Food Security and Public Health Iowa State University -
2004
26

27. 27