Q fever

Q fever is a zoonotic disease that causes 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. 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 fevers (up to 104-105°F), severe headache, general malaise, myalgia, chills and/or sweats, 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.

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), pain in muscles and joints, mood changes, and difficulty sleeping.

A 2006 prospective study found that 11% of subjects infected by 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). 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."

Dr. Dragan Ledina writes about Q fever and ME/CFS.

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. Development of chronic Q fever (QFS) in infected patients remains an important problem in the Netherlands to this day.

Notable studies
Q fever is known to trigger chronic fatigue in some patients, often referred to as Q Fever Fatigue Syndrome (QFS).

Coxiella burnetii dormancy in a fatal ten-year multisystem dysfunctional illness: case report.

A 2016 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."

In 2002, D. Raoult wrote an essay, "Q fever: still a mysterious disease" for QJM: An International Journal of Medicine and which he stated:"'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.(emphasis added)'"

In the same journal, Marmion, B.P., et al., deconstructed Raoult's techniques and theory:"'The time is well past for sceptical opinion from the sidelines based on experience in unrelated Q fever research(emphasis added). 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.' In conclusion, Marmion, et al., showed that more advanced assay methods identified 'some 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]."

Research papers

 * 2016, The natural history of acute Q fever: A prospective Australian cohort
 * 2017, Q Fever: Confusion Between Chronic Infection and Chronic Fatigue
 * 2018, Challenging queries of Q fever: emphasizing Q fever fatigue syndrome (Full Text)
 * 2019, Cytokine profiles in patients with Q fever fatigue syndrome (Abstract)