Texas Man Mysteriously
Comes Down With Q Fever
From Patricia Doyle, PhD

Texas Man Mysteriously Gets Rare Illness
Washington Post
State health officials are looking into how a Panhandle [the northernmost part of Texas] man contracted a rare bacterial disease that typically is tied to the livestock industry. The Moore County man does not work around livestock or in a laboratory or slaughterhouse and is not a veterinarian, circumstances normally associated with getting Q fever, said Dr. James Alexander, a vet with the Department of State Health Services in Canyon. It's possible the man might have caught the disease, which can spread from animals to humans, from contaminated soil, Alexander said.
The patient told officials he has a friend with livestock but that he had no contact with the animals, Alexander said.
Cattle, sheep, and goats are the primary carriers of the bacteria [that cause Q fever], known as _Coxiella burnetii_, according to the Centers for Disease Control and Prevention website. It's extremely rare for the disease to spread from human to human, said Dr. Steven Berk, regional dean for Texas Tech University Health Sciences Center School of Medicine and an expert on infectious diseases. Common symptoms resemble a serious case of the flu. A high fever comes on suddenly, and those who get infected experience chills and sweating, a general feeling of sickness and loss of appetite. Blood tests are used to test for Q fever, and it responds to antibiotics. Patients usually recover promptly when treatment is started without delay.
Hello Jeff: I am concerned about the Q Fever case in the panhandle of Texas. Q Fever can spread via aerosol if it has been weaponized.
Anti-Bioterrorism training teaches us that on occassions bioterrorists will "test" a small sample of their weaponized agent on one person or a small number of people. This gives them an idea as to dispersal technique as well as power of the agent itself.
Coxiella burnetii, a gram-negative coccobacillus, is resistant to heat and desiccation and is highly infectious by the aerosol route. This organism is very stable in the environment.The incubation period of Q Fever can be 10 - 40 days, inversely proportional to dose. It is possible that we will see more cases within the next 40 days. It is also possible that a case or more have gone undetected. Perhaps, there have been deaths that have gone undiagnosed. The Texas health department will have to backtrack and look into all undiagnosed deaths.
Given the area there may be people who have immunity to Q Fever, those who work in the cattle industry. Asymptomatic cases are a real possibility.
In addition to asymptomatic infections, Q fever has a panoply of acute and chronic, usually nonfatal, manifestations that vary probably related to the dose, and perhaps to the local strain of Q fever organism. Acute pictures include a self-limiting febrile illness of 2-14 days duration, pneumonia, hepatitis, and aseptic meningitis or encephalitis; chronic manifestations include endocarditis, fever of unknown origin, and a variety of other symptoms in immunosuppressed individuals. Febrile illness usually includes a severe frontal or retro-orbital headache, chills, fatigue, sweats, and myalgias; though cough may occur, coryza and arthralgias are absent. Gastrointestinal symptoms of nausea, vomiting, and diarrhea occur in 20%. Pneumonia occurs in about half of all patients. Patients may have either radiographic or physical evidence of pneumonia, or both. Pneumonia may present as fever with no pulmonary symptoms, atypical pneumonia, or rapidly progressive pneumonia. In addition to the nonspecific symptoms listed above, pleuritic chest pain may also occur. Rales are probably the most common physical finding. Patients with rapidly progressing pneumonia often have the signs of pulmonary consolidation. Patients may present with an acute hepatitis (particularly in sheep- or goat-breeding areas) or elevated liver function tests may simply be an ancillary finding. Finally, altered mental status may lead to suspicion of meningitis or encephalitis; although the CSF is usually normal, an increased WBC count with a mononuclear predominance may be observed.
Since naturally-occurring outbreaks of Q fever are reported, an outbreak from a terror source could be difficult to distinguish from a natural one. Further, the protean manifestations require differentiation from diseases ranging from a wide variety of diseases. The acute febrile illness would need to be distinguished from influenza and dengue as well as the prodrome of a variety of bacterial or viral illnesses. The rounded densities evident on chest radiograph call to mind Legionnaire's disease and tularemia. Other causes of atypical pneumonia such as Mycoplasma pneumoniae, Legionella pneumophila, Chlamydia psittaci, and Chlamydia pneumoniae as well as agents such as Yersinia pestis associated with rapidly progressive pneumonia should also be considered. Acute hepatitis would need to be differentiated from the usual causes of hepatitis (e.g., A, B, and C). Likewise, the occasional case that presents with primary meningitis/encephalitis would need to be differentiated from the usual viral causes of aseptic meningitis/encephalitis and occasionally form agents associated with pleocytic CSF with a mononuclear predominance-listeriosis, leptospirosis, lymphocytic choriomeningitis, tuberculosis, and Rocky Mountain spotted fever.
It is very important for people in the panhandle area of Texas to be very vigilant and report any flulike symptoms to the doctor. When in crowds, especially during the July 4th holiday celebrations be extra vigilant. Report any suspicious activity to the nearest police officer.
Q Fever as a bioterrorist agent can be found here: htttp://www.ore
Patricia Doyle

From ProMEDmail
From James Alexander
A person was diagnosed with Q-fever in mid-May 2005. His physician first thought he had brucellosis, due to the patient having night sweats. However, the initial serology indicated Q-fever. His MD obtained a 2nd sample and the Texas Department of State Health Services laboratory also obtained high Phase II IgM antibody levels. The person has responded well to doxycycline and appears to have recovered. His source of exposure remains unknown at present. The only animal contact reported is a pet dog. The person had recently applied a commercial compost product to his garden. The origin of the compost has not yet been determined. The individual reported that he came out from his work place (non-agricultural) one evening and the area was full of dust, presumably from one or more cattle feedlots in the area.
The investigation is ongoing and may involve the submission of compost material for analysis to determine if _Coxiella_ DNA is present. Distances from feedlots will also be determined.
James L. Alexander, DVM, MPVM., Dipl. ACVPM
Regional Zoonosis Control Veterinarian
Texas Department of State Health Services
Health Service Region 1
WTAMU Box 60968
Canyon, TX 79016-0968
(806) 655-7151
Fax (806) 655-1354
ProMed Mail
(Jim's investigation of this case is ongoing, and we are promised information as he receives it and can share it. Stay tuned! And thanks to Jim for being willing to share his information with us. Presumably the public knowledge of this case will trigger the sharing of information of other recent cases, human and livestock, in Texas and adjoining states, including Mexico. - Mod.MHJ_)
Patricia A. Doyle, PhD
Please visit my "Emerging Diseases" message board.
Zhan le Devlesa tai sastimasa
Go with God and in Good Health



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