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Q or “Query” fever is an infection in humans caused by the Gram-negative bacterium . The disease occurs worldwide and most often presents as an acute febrile illness, although chronic disease may occur in the form of endocarditis or vascular infections. Livestock, particularly cattle, goats, and sheep, are considered the primary reservoirs for the agent, although many other veterinary species may be infected. Bacteria shed by infected livestock are infectious, and large numbers of bacteria can be released during parturition. Certain high-risk occupations have been identified, such as abattoir workers and dairy farmers; however, the aerosol transmission route, low infectious dose (<10 organisms), and stability in the environment can result in wind-borne transmission distal to the veterinary source. Antibiotic treatment is effective, with doxycycline the drug of choice for acute infections; treatment of chronic disease requires long-term therapy, with both doxycycline and hydroxychloroquine currently recommended. A human vaccine (Q-VAX) has been licensed but is currently only available in Australia. Diagnostic methods include serology, molecular methods, immunohistochemistry, and isolation, with this last restricted to high-containment (BSL-3) facilities. Genetic analyses based on whole genome sequencing, targeted gene sequencing, and genotyping methods have suggested that strains can vary based on reservoir host and geographic distribution. Although recent advances have improved our understanding of Q fever, further studies are needed to address the epidemiology, control, and prevention of the disease.

Citation: Graves S, Massung R. 2015. *, p 1150-1158. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch66
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Image of FIGURE 1

Scanning electron micrograph of (orange) in the parasitophorous vacuole of a cryo-prepared Vero cell infected with phase II strain Nine Mile. (Courtesy of Beth Fischer and Robert Heinzen, Rocky Mountain Laboratories, NIAID, NIH.) doi:10.1128/9781555817381.ch66.f1

Citation: Graves S, Massung R. 2015. *, p 1150-1158. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch66
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Image of FIGURE 2

Hematoxylin and eosin stain of a liver biopsy specimen from a patient with acute Q fever. A doughnut ring granuloma is shown. Original magnification, ×400. (Courtesy of H. Lepidi, Marseille, France.) doi:10.1128/9781555817381.ch66.f2

Citation: Graves S, Massung R. 2015. *, p 1150-1158. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch66
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Image of FIGURE 3

Alkaline phosphatase IHC on a heart valve from a patient with chronic Q fever endocarditis. microorganisms are stained pink within mononuclear cells. Original magnification, ×400. doi:10.1128/9781555817381.ch66.f3

Citation: Graves S, Massung R. 2015. *, p 1150-1158. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch66
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Image of FIGURE 4

Identification of in shell vial culture at day 6 by use of a specific monoclonal antibody-based direct fluorescent-antibody test. Original magnification, ×1,000. doi:10.1128/9781555817381.ch66.f4

Citation: Graves S, Massung R. 2015. *, p 1150-1158. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch66
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