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RAMESH.KASARLAPharmD Intern 170514883003

svcp

Introduction Q Fever is a disease caused by infection with Coxiella

burnetii.

Coxiella burnetii Obligate intracellular, gram negative

bacterium

Q stands for Query or Queensland

Origin of disease unknown

First reported cases were in Queensland, Australia

Distributed globally

Found in many species of animals

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C. burnetii

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en.wkipedia.org

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Culture Grows well in yolk sac of chick embryos

and in various cell cultures .

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structure shows phase variation . phase – I ,II . phase – I :- autoagglutinable more immunogenic activity due to

periodate sensitive trichloracetic acid-soluble surface carbohydrate .

o Phase – II :- more suitable for complement fixation test (CFT) .

o both phase I ,II elicit good Ab response .

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Resistance Resistant to physical and chemical agents Can survive in dust and aerosols Inactivated by 2% formaldehyde 5% H2O2 1% Lysol . Resistant to heat, drying and disinfectants Air samples test positive for 2+ weeks Soil samples test positive for 150+ days Spore formation

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PATHOGENESIS

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Primary Reservoir

Cattle Sheep

Goats

* All eukaryotes can be infected

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Bacteria is excreted in:

Feces

Urine

Milk

of infected animals

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Release Into Environment:- During birthing the organisms are shed in high

numbers in amniotic fluids and the placenta 109 bacteria per gram of placenta

Do not touch!

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Transmission Most common route is inhalation of aerosols Contaminated dust, manure, birthing products Tick bites (rare) Person-to-person (rare)

Transplacental (congenital)Blood transfusionsBone marrow transplantsIntradermal inoculationPossibly sexually transmitted

gsbs.utmb.edu

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Who’s at risk? Farmers, veterinarians, researchers,

abattoir (slaughterhouse) workers etc. People who breed animals Immunocompromised

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Phagocytosis

Binding/entry into macrophages via: Integrin Associated Protein (IAP) Leukocyte Response Integrin (LRI)

macrophage bacteria

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Lysis of phago-lysosome and macrophage

Phago-lysosome fusion: bacteria survive and multiplies

Phagocytic vesiclePhagocytosis

Binding & Entry

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*Bacteria spread through blood

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Acute or Chronic Q fever

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SymptomsAcute Q fever

Self-limiting, flu-like disease Fever, nausea, headaches, vomiting, chest/abdominal

pain Pneumonia & granulomatous hepatitis Other signs (< 1%)

Myocarditis, pericarditis, meningoencephalitis Death: 1-2%

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 A: A normal B: Q Fever pneumonia

Chest X-ray

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Chronic Q fever (> 6 months)

Endocarditis & meningoencephalitis Pre-existing disease 1-5% of those infected

Prior heart disease, pregnant women, immunocompromised

OtherOsteomyelitisGranulomatous hepatitisCirrhosis

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LAB DIAGNOSISHard to diagnose because:

Asymptomatic in most cases Looks like other disease (Flu or cold) Serology continues to be best method PCR, ELISA and other methods WEIL – FELIX test is negative . Bio safety level 3 (BSL-3) facility

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Treatment Once infected, humans can have life-long immunityAcute Q fever treated with: Doxycycline (100 – 200 mg/day) Chloramphenicol (Adult : 50 – 100 mg/kg/day Child : 25 – 50mg/kg/day) Erythromycin (Adult : 1-2 g/day up to 4gm/day Child : 30 -50 mg/day up to 1g/day) Timethoprim/sulfamethoxazole (160/800 mg)Fluoroquinolones:- Ciprofloxacin, Gemifloxacin, Levofloxacin, Moxifloxacin Norfloxacin, Ofloxacin

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For acute Q fever, doxycycline is the drug of choice, and 2 weeks of treatment is recommended for adults, children aged ≥8 years, and for severe infections in patients of any age.

Children aged < 8 years with uncomplicated acute illness may be treated with trimethoprim/sulfamethoxazole (160/800 mg) or a shorter duration (5 days) of doxycycline.

Women who are pregnant when acute Q fever is diagnosed should be treated with trimethoprim/sulfamethoxazole throughout the duration of pregnancy

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Chronic Q fever Chronic Q fever is difficult to treat, therefore a prolonged

antimicrobial regimen is recommended. The most current recommendation for endocarditis is

combination treatment with doxycycline and hydroxychloroquine for at least 18 months to eradicate any remaining C burnetii and prevent relapses.

An alternative option is combination of doxycycline and a fluoroquinolone for at least 3-4 years.

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The vaccine is not recommended for children younger than 15 years old.

Before you are vaccinated, your doctor will perform skin and antibody tests to see if you have been already exposed to the infection and are immune to it. If the tests show that you’re already immune you will not need to be vaccinated.

The safety of this vaccine has not been tested in pregnant women and breastfeeding so vaccination is not recommended.

Vaccine :

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Q-Vax Skin Test – CSL Limited (Q fever skin test). Each 0.5 mL liquid vial when diluted to 15 mL with sodium chloride contains 16.7 ng of purified killed suspension of C. burnetii in each diluted 0.1 mL dose; thiomersal 0.01% w/v before dilution. Traces of formalin. May contain egg proteins.

Q-Vax – CSL Limited (Q fever vaccine). Each 0.5 mL pre-filled syringe contains 25 µg purified killed suspension of Coxiella burnetii; thiomersal 0.01% w/v. Traces of formalin. May contain egg proteins.

Side effects Headache is a common side effect of the Q fever vaccine that may

affect 1 to 10 in every 100 people

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Prevention and Control:- Pasteurization and sterilization of milk and other

dairy products Disinfect utensils, machines used in farm areas

for birthing Regular testing of animals and those who work

closely with them Protective Personal Equipment Isolate new animals

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Reference http://www.cdc.gov/qfever/ https://en.wikipedia.org/wiki/Q_fever http://emedicine.medscape.com/article/227156-medication http://www.healthline.com/health/q-fever#Complications6 http://www.nps.org.au/medicines/immune-system/vaccines-and-

immunisation/for-individuals/vaccines-a-z/q-fever Center for Food Security and Public Health Iowa State University -

2004

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