Suspected Q Fever Exposure
The purpose of these policy guidelines is to recommend procedures for handling potential biological threats of Q Fever Exposure.
Description of Agent/Syndrome
Q fever is a zoonotic disease caused by the bacteria CoxieIIa burn etii. Cattle, sheep and
goats are the primary reservoirs in naturally occurring illness. The potential
for use of this organism as a biological threat exits because it is highly
infectious, is rather resistant to heat and drying, can become airborne and
inhaled by humans and a small number of organism can cause illness.
Transmission
1. Airborne dust particles
contaminated with the organism from animals or direct contact with infected
animals or their byproducts.
2. Airborne as biological weapon.
3. Person to person transmission is
considered rare.
Incubation Period
10-40 days (depends on the size of the infecting
dose)
Signs and Symptoms:
1.
Only about one-half of people infected will show signs of
clinical illness.
2.
Most acute cases begin with sudden onset of one or more of
the following: high fever, severe headache, general malaise, myalgia,
confusion, sore throat, chills, sweats, nonproductive cough, nausea, vomiting,
diarrhea, abdominal pain and chest pain.
3.
Fever may last 1-2 weeks.
4.
Thirty to fifty percent of patient with symptomatic
infection will develop pneumonia.
5.
Abnormal liver function is common.
6.
Most patients recover without treatment.
7. Mortality rate is low (1-2%).
8.
Chronic infection is uncommon but potentially more serious
resulting in endocarditis.
Diagnosis
1.
An accurate diagnosis is difficult without laboratory
confirmation since signs and symptoms are general.
2. Culturing of the organism is difficult and not generally available.
3.
Confirmation is by serologic testing to detect antibodies to
Coxiella burn etii antigens.
1.
Doxycycline (100mg orally 2 x per day for 15-21 days) is the
treatment of choice for acute Q Fever and is most effective when started within
the first 3 days of illness.
2.
Quinilones may also be considered since they have shown good
in vitro activity.
3.
Therapy should be repeated for relapse.
4.
Chronic Q fever endocarditis is more difficult to treat
often requires multiple drugs.
Prophylaxis
Notification
Internal: At hospital notify________________________________
External: All suspected cases of 0 Fever are Class A2
Reportable and should be reported immediately to the Local Health Department
who will then contact the State Health Department and/or CDC.
Lab
Due to potential risks associated with handling
infectious materials, laboratory testing should be the minimum necessary for
diagnostic evaluation and patient care. Laboratory specimens should be placed
in plastic bags that are sealed, and then transported in clearly labeled,
durable, leak-proof sterile containers directly to the specimen handling area
of the laboratory. Care should be taken not to contaminate the external
surfaces of the container. Lab personnel should be notified of what they are
handling. Bio-Safety Level 2 should be used for handling specimens.
|
Q Fever (Coxiella
bumettii) |
2 Red-top or Gold-Top Tubes (For serology) |
ID Consult |
Note on requisition |
|
Possible Coxiella burnettii in an
asymptomatic patient |
No |
No |
Not
applicable |
|
Q Fever |
Yes |
Yes |
R/O Q fever |
References
1.
American Public Health Association 2000. 0 Fever IN: Chin J.
ed. Control of Communicable Diseases
Manual. Washington DC; American Public Health Association; 407-411
2.
Association for Practitioners in Infection Control and
Epidemiology 2000. APIC Text of Infection
Control and Epidemiology; 39-1; 63-4; 124-ito 124-li.
3. Center for Disease Control and Prevention. Disease Information Q Fever via internet http://www.cdc.gov/ncidod/dvrd/qfever/index.htm
Note: These are guidelines that have been
developed with data available as of 5/9/02.
Initially Prepared by
The Akron Regional Hospital
Association
Emergency Preparedness
Subcommittee
August 20, 2002