Editing Q fever

'''Q fever''', also called '''query fever''', is a [[Zoonotic diseases|zoonotic disease]] that causes both acute or chronic phases in humans. The infectious agent, the ''[[Coxiella burnetii]]'' bacterium, is acquired after contact with infected animals, especially goats, sheep, and cattle, or exposure to environments contaminated with the urine, feces or amniotic fluid of infected animals.<ref>{{Cite web|url=https://www.healthline.com/health/q-fever| title = Q Fever: Causes, Symptoms & Diagnosis| date = 2012-08-07 | website = Healthline|language=en|access-date=2020-07-24}}</ref><ref>{{Cite web|url=https://www.cdc.gov/qfever/index.html| title = Q Fever {{!}} Q Fever {{!}} CDC| date = 2019-09-16 | website = [[Centers for Disease Control and Prevention]]|language=en-us|access-date=2020-07-24}}</ref> 

==Symptoms==
The acute symptoms usually develop within 2-3 weeks of exposure, although as many as half of humans infected with ''C. burnetii'' do not show symptoms. The combination of symptoms varies greatly from person to person, but often present as: high [[fever]]s (up to 104-105°F), severe [[headache]], general [[malaise]], [[myalgia]], chills and/or sweating episodes, non-productive [[cough]], [[nausea]], [[vomiting]], [[diarrhea]], [[abdominal pain]], and [[chest pain]]. Complications with serious cases may include [[pneumonia]], [[granulomatous hepatitis]] (inflammation of the liver), [[myocarditis]] (inflammation of the heart tissue), central nervous system complications, and pre-term delivery or miscarriage.<ref name=":0">{{Cite web|url=https://www.cdc.gov/qfever/symptoms/index.html| title = Signs and Symptoms {{!}} Q Fever {{!}} CDC | last = CDC | first = | authorlink = Centers for Disease Control and Prevention | date = 2017-12-26 | website = [[Centers for Disease Control and Prevention]]|language=en-us|archive-url=|archive-date=|url-status=|access-date=2019-01-12}}</ref>

Chronic Q fever may present within 6 weeks after an acute infection or may manifest months or years later. The three groups at highest risk for chronic Q fever are pregnant women, immunosuppressed persons and patients with a pre-existing heart valve defects. Although the majority of people with acute Q fever recover completely, a post-Q fever fatigue syndrome (QFS) has been reported to occur in 10-25% of acute patients. This syndrome is characterized by constant or recurring [[fatigue]], [[night sweats]], severe headaches, [[photophobia]] (eye sensitivity to light), [[Myalgia|pain in muscles]] and [[Arthralgia|joints]], [[Mood swings|mood changes]], and [[Insomnia|difficulty sleeping]].<ref name=":0" /> 

==ME/CFS==
Q fever is known to trigger chronic fatigue in some patients, often referred to as Q Fever Fatigue Syndrome (QFS).<ref name="Keijmel2015" />

A 2006 prospective study found that 11% of subjects infected with Q fever met the criteria for [[chronic fatigue syndrome]] six months after their infection. (The same rate held true for [[Epstein-Barr virus]] and [[Ross River virus]]).<ref>{{Cite journal | last = Hickie | first = Ian | last2 = Davenport | first2 = Tracey | last3 = Wakefield | first3 = Denis | last4 = Vollmer-Conna | first4 = Ute | last5 = Cameron | first5 = Barbara | last6 = Vernon | first6 = Suzanne D. | last7 = Reeves | first7 = William C. | last8 = Lloyd | first8 = Andrew | last9 = Dubbo Infection Outcomes Study Group| date = 2006-09-16| title = Post-infective and chronic fatigue syndromes precipitated by viral and non-viral pathogens: prospective cohort study|url=https://www.ncbi.nlm.nih.gov/pubmed/16950834|journal=BMJ (Clinical research ed.)|volume=333|issue=7568|pages=575|doi=10.1136/bmj.38933.585764.AE|issn=1756-1833|pmc=1569956|pmid=16950834|quote= | author-link = Ian Hickie | authorlink2 = Tracey Davenport|access-date= | authorlink3 = Denis Wakefield | author-link4 = Uté Vollmer-Conna | authorlink5 =  | authorlink6 = Suzanne Vernon|via= | authorlink7 = William Reeves | authorlink8 = Andrew Lloyd}}</ref> In a 2015 study, QFS patients were compared with [[chronic fatigue syndrome]] (CFS) patients: "In all analyses QFS patients were as fatigued and distressed as CFS patients, but reported less additional symptoms. QFS patients had stronger somatic attributions, and higher levels of physical activity. No differences were found with regard to inflammatory markers and in other fatigue-related cognitive-behavioral variables."<ref name="Keijmel2015">{{Cite journal | last = Keijmel | first = Stephan P. | author-link = | last2 = Saxe | first2 = Johanna | authorlink2 = | last3 = van der Meer | first3 = Jos W. M. | authorlink3 = Jos van der Meer | last4 = Nikolaus | first4 = Stephanie | authorlink4 = | last5 = Netea | first5 = Mihai G. | authorlink5 = | last6 = Bleijenberg | first6 = Gijs | authorlink6 = Gijs Bleijenberg | last7 = Bleeker-Rovers | first7 = Chantal P. | authorlink7 = Chantal Bleeker-Rovers | last8 = Knoop | first8 = Hans | authorlink8 = | date = Oct 2015 | title = A comparison of patients with Q fever fatigue syndrome and patients with chronic fatigue syndrome with a focus on inflammatory markers and possible fatigue perpetuating cognitions and behaviour |url =https://www.ncbi.nlm.nih.gov/pubmed/26272528|journal=Journal of Psychosomatic Research|volume=79|issue=4|pages=295–302|doi=10.1016/j.jpsychores.2015.07.005|issn=1879-1360|pmid=26272528|quote=|via=|pmc=|access-date=}}</ref>

A 2020 study done in the Netherlands studied patterns of the gut [[microbiome]], blood metabolome, and inflammatory proteome of QFS patients, and compared these with those of chronic fatigue syndrome (CFS) patients and healthy controls (HC). They found that although QFS patients show more of an inflammatory profile than CFS patients and HC, when comparing QFS patients to CFS patients, there is a striking resemblance and hardly any significant differences in microbiome taxonomy are found.<ref name=":1" /> 

Dr. [[Dragan Ledina]] writes about Q fever and [[ME/CFS]].<ref>{{Cite web|url=http://www.investinme.org/Article-270%20Chronic%20Fatigue%20Syndrome%20After%20Q%20fever.htm| title = Chronic Fatigue Syndrome after Q fever | last=Ledina | first=Dragan | authorlink=Dragan Ledina| date = |website=[[Invest in ME]]|archive-url=|archive-date=|url-status=|access-date=2019-01-12}}</ref>

==Netherlands epidemic==
In 2005, Q fever was diagnosed on two dairy goat farms in the rural farm land in the southern area of the [[Netherlands]]. By 2010, more than 4,000 human cases were diagnosed, overwhelming the hospital, health care and veterinary care systems.<ref>{{Cite journal | last = van der Hoek | first = Wim | author-link = | last2 = Morroy | first2 = Gabriëlla | authorlink2 = | last3 = Renders | first3 = Nicole H. M. | authorlink3 = | last4 = Wever | first4 = Peter C. | authorlink4 = | last5 = Hermans | first5 = Mirjam H.A. | author-link5 = | last6 = Leenders | first6 = Alexander C. A.P. | last7 = Schneeberger | first7 = Peter M.| date = 2012 | title = Epidemic Q fever in humans in the Netherlands|url=https://www.ncbi.nlm.nih.gov/pubmed/22711640|journal=Advances in Experimental Medicine and Biology|volume=984|issue=|pages=329–364|doi=10.1007/978-94-007-4315-1_17|issn=0065-2598|pmid=22711640|quote=|via=|pmc=|access-date=}}</ref> Development of chronic Q fever (QFS) in infected patients remains an important problem in the Netherlands to this day.<ref>{{Cite journal | last = Dijkstra | first=Frederika | author-link = | last2 = van der Hoek | first2 = Wim | author-link2 = | last3 = Wijers | first3 = Nancy | authorlink3 = | last4 = Schimmer | first4 = Barbara | authorlink4 = | last5 = Rietveld | first5 = Ariene | authorlink5 = | last6 = Wijkmans | first6 = Clementine J. | authorlink6 = | last7 = Vellema | first7 = Piet | last8 = Schneeberger | first8 = Peter M. | date = Feb 2012| title = The 2007–2010 Q fever epidemic in The Netherlands: characteristics of notified acute Q fever patients and the association with dairy goat farming | url =https://www.ncbi.nlm.nih.gov/pubmed/22066649|journal=FEMS immunology and medical microbiology|volume=64|issue=1|pages=3–12|doi=10.1111/j.1574-695X.2011.00876.x|issn=1574-695X|pmid=22066649|quote=|via=|pmc=|access-date=}}</ref>

== Notable studies ==
* 2002, D. Raoult wrote an essay, "Q fever: still a mysterious disease" for ''QJM: An International Journal of Medicine'' and which he stated:<blockquote>"It has been reported following Q fever in Australia and in the UK. In contrast, few cases of post‐Q‐fever fatigue have been documented from France and Canada. Wildman et al., in this issue of the journal, found that in the follow‐up of patients with Q fever, fatigue and [[idiopathic chronic fatigue]] were found in nearly 65% of patients, twice as frequently as in controls. Whether this fatigue is psychological in origin, or directly caused by the bacterium, is unknown''.''"<ref>{{Cite journal | last = Raoult | first= D. | date = 2002-08-01| title = Q fever: still a mysterious disease|url=https://academic.oup.com/qjmed/article-lookup/doi/10.1093/qjmed/95.8.491|journal=QJM|volume=95|issue=8 | pages = 491–492|doi=10.1093/qjmed/95.8.491}}</ref></blockquote>
* 2002, Marmion, B.P., et al., deconstructed Raoult's techniques and theory:
<blockquote> "The time is well past for sceptical opinion from the sidelines based on experience in unrelated Q fever research. We submit that it is now time for Dr Raoult's group to follow accepted scientific process and to attempt to confirm our results locally now that they have identified the fatigue syndrome (QFS=‘asthenia Q fever’) in French patients. It is necessary to follow patients systematically for more than two years after the initial acute infection." Marmion, et al., showed that more advanced assay methods identified approximately 8–10% of Q fever patients, who exhibit similar symptoms but do not reach immune or other homeostasis after one year or longer that constitute the serious social and medical problem known as Q fever fatigue syndrome.<ref>{{Cite journal | last = Marmion | first = B.P. | date = 2002-12-01| title = Q fever: still a mysterious disease|url=https://academic.oup.com/qjmed/article-lookup/doi/10.1093/qjmed/95.12.832|journal=QJM|volume=95|issue=12 | pages = 832–833|doi=10.1093/qjmed/95.12.832}}</ref></blockquote>
* 2016, Coxiella burnetii dormancy in a fatal ten-year multisystem dysfunctional illness: case report.<ref name="dormancy">{{Cite journal | last = Sukocheva | first=Olga A. | last2 = Manavis | first2 = Jim | last3 = Kok | first3 = Tuck-Weng | last4 = Turra | first4 = Mark | last5 = Izzo | first5 = Angelo | last6 = Blumbergs | first6 = Peter | last7 = Marmion | first7 = Barrie P. | date = 2016-04-18| title = Coxiella burnetii dormancy in a fatal ten-year multisystem dysfunctional illness: case report|url=https://doi.org/10.1186/s12879-016-1497-z|journal=BMC Infectious Diseases|volume=16|issue=1|pages=165|doi=10.1186/s12879-016-1497-z|issn=1471-2334|pmc =  4835832|pmid=27091026}}</ref>

* 2016, a literature review concluded that: "Long-term fatigue following acute Q-fever, generally referred to as QFS, has major health-related consequences. However, information on aetiology, prevention, treatment, and prognosis of QFS is underrepresented in the international literature."<ref>{{Cite journal | last = Morroy | first = Gabriella | author-link = | last2 = Keijmel | first2 = Stephan P. | authorlink2 = | last3 = Delsing | first3 = Corine E. | authorlink3 = | last4 = Bleijenberg | first4 = Gijs | authorlink4 = Gijs Bleijenberg | last5 = Langendam | first5 = Miranda | authorlink5 = | last6 = Timen | first6 = Aura | authorlink6 = | last7 = Bleeker-Rovers | first7 = Chantal P. | date = 2016-05-25 | editor-last = Samuel | editor-first = James E| title = Fatigue following Acute Q-Fever: A Systematic Literature Review | url =https://dx.plos.org/10.1371/journal.pone.0155884|journal=PLOS ONE|language=en|volume=11|issue=5| pages = e0155884|doi=10.1371/journal.pone.0155884|issn=1932-6203|pmc =  4880326|pmid=27223465|access-date=|quote=|via=}}</ref>
* 2020, Multi-omics examination of Q Fever Fatigue Syndrome identifies similarities with Chronic Fatigue Syndrome<ref name=":1">{{Cite journal | last = Raijmakers | first = Ruud | last2 = Roerink | first2 = Megan E. | last3 = Jansen | first3 = Anne F.M. | last4 = Keijmel | first4 = Stephan P. | last5 = Gacesa | first5 = Ranko | last6 = Li | first6 = Yang | last7 = Joosten | first7 = Leo A.B. | last8 = Meer | first8 = Jos W.M. van der | last9 = Netea | first9 = Mihai G. | date = 2020-08-19| title = Multi-omics Examination of Q Fever Fatigue Syndrome Identifies Similarities with Chronic Fatigue Syndrome|journal =Journal of Translational Medicine|url=https://www.researchsquare.com/article/rs-54097/v1|doi=10.21203/rs.3.rs-54097/v1}}</ref>

==Research papers==
*2016, The natural history of acute Q fever: A prospective Australian cohort<ref name="Hopper2016">{{Cite journal | last = Hopper | first=B. | author-link = | last2 = Cameron | first2 = B. | authorlink2 = | last3 = Li | first3 = H. | authorlink3 = | last4 = Graves | first4 = S. | authorlink4 = | last5 = Stenos | first5 = J. | authorlink5 = | last6 = Hickie | first6 = I. | authorlink6 = Ian Hickie | last7 = Wakefield | first7 = D.  | authorlink7 = Denis Wakefield | last8 = Vollmer-Conna | first8 = U. | authorlink8 = Uté Vollmer-Conna | last9 = Lloyd | first9 = A.R. | authorlink9 = Andrew Lloyd| date = 2016-10-01| title = The natural history of acute Q fever: a prospective Australian cohort|url=https://academic.oup.com/qjmed/article/109/10/661/2440064|journal=QJM: An International Journal of Medicine|language=en|volume=109|issue=10 | pages = 661–668|doi=10.1093/qjmed/hcw041|issn=1460-2725|pmc=|pmid=|access-date=|quote=|via=}}</ref>
*2017, [https://doi.org/10.1093/cid/cix469 Q Fever: Confusion Between Chronic Infection and Chronic Fatigue]<ref>{{Cite journal | last = Raoult | first=Didier| date = 2017-09-15| title = Q Fever: Confusion Between Chronic Infection and Chronic Fatigue|url=http://academic.oup.com/cid/article/65/6/1054/3830164/Q-Fever-Confusion-Between-Chronic-Infection-and|journal=Clinical Infectious Diseases|language=en|volume=65|issue=6|pages=1054–1055|doi=10.1093/cid/cix469|issn=1058-4838}}</ref>
*2018, Challenging queries of Q fever: emphasizing Q fever fatigue syndrome<ref>{{Cite journal | last = Keijmel | first = S.P. | author-link =  | date = 2018 | title=Challenging queries of Q fever, emphasizing Q fever fatigue syndrome|url=https://repository.ubn.ru.nl/handle/2066/187512|journal=Radboud University Dissertation|volume=|issue=|pages=|doi=|pmc=|pmid=|access-date=|quote=|via=}}</ref> - [http://repository.ubn.ru.nl/bitstream/handle/2066/187512/187512.pdf (Full Text)]
*2019, Cytokine profiles in patients with Q fever fatigue syndrome<ref name="Raijmakers2019">{{Cite journal | last = Raijmakers | first = Ruud P.H. | author-link = | last2 = Koeken | first2 = Valerie A.C.M. | authorlink2 = | last3 = Jansen | first3 = Anne F.M. | authorlink3 = | last4 = Keijmel | first4 = Stephan P. | authorlink4 = | last5 = Roerink | first5 = Megan E. | authorlink5 = | last6 = Joosten | first6 = Leo A.B. | authorlink6 = | last7 = Netea | first7 = Mihai G. | authorlink7 = | last8 = van der Meer | first8 = Jos W.M. | authorlink8 = Jos van der Meer | last9 = Bleeker-Rovers | first9 = Chantal P. | authorlink9 = | date = Jan 2019| title = Cytokine profiles in patients with Q fever fatigue syndrome|url=https://linkinghub.elsevier.com/retrieve/pii/S0163445319300271|journal=Journal of Infection|language=en|volume=|issue=|pages=|doi=10.1016/j.jinf.2019.01.006|quote=|via=}}</ref> - [[pubmed:30684502|(Abstract)]]

==See also==
* [[Coxiella burnetii]]
* [[Dragan Ledina]]
* [[Zoonotic diseases]]

==Learn more==
*[http://www.investinme.org/Article-270%20Chronic%20Fatigue%20Syndrome%20After%20Q%20fever.htm Chronic Fatigue Syndrome after Q fever] - [[Invest in ME Research]]

==References==
{{Reflist}}

[[Category:Infectious diseases]]
[[Category:Triggers and risk factors]]
[[Category:Disease]]
[[Category:Diagnoses]]
[[Category:Bacterial diseases]]