A 58-year-old man with rheumatoid arthritis presented to the emergency room with fevers and drenching night sweats. He was found to have granulomatous hepatitis and his Coxiella burnetii serologic tests were positive. He had no livestock exposures.
What is Q fever?
Q fever is a worldwide zoonotic disease caused by the intracellular bacterium C. burnetii.
How would I get infected?
Infection begins with the inhalation of spores that originate in infected cattle, sheep, and goats.
Where in the United States is Q fever most common?
States with the highest incidence include Utah, Oregon, and Nebraska, but the illness has also been reported in California and Texas.
What is the incubation period?
Typically 2-3 weeks.
Are the spores hearty?
Yes, they can survive for extended periods in the environment and can be carried by the wind over long distances, occasionally farther than 10 miles. This durability and transmissibility may explain why many patients with Q fever have no known exposure to livestock.
Does this mean that Q fever can be transmitted by the airborne route?
Yes. Just like anthrax.
What are the implications of this case?
I think our modern agriculture system, based on the consumption of animal products, needs to be rethought. I advise my patients to consider a vegan diet.
To learn more, consider reading the New England Journal of Medicine case upon which this blog post was based.