- 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
- 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 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
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