Nature
Q fever, also known as Query Fever, is a widespread zoonist, which was first described in 1947 in southern California (Akamine et al., 2019). The disease’s causative agent is an obligate intracellular gram-negative bacteria Coxiella burnetii (Akamine et al., 2019). The disease is associated with exposure to livestock which can be carriers of bacteria. Although various species can be infected with fever, goats and sheep are the primary reservoirs for the bacteria (Kaufman et al., 2018). Thus, the disease is usually transmitted to humans through contact with pets and cattle.
Extent and Significance
Estimates of morbidity and mortality rates for Q fever vary by area of study. However, studies note overall moderate morbidity and a low mortality rate (Berger, 2020). Clinical cases of the disease in different countries vary from 1 to 30 cases per million people, can occur sporadically or as outbreaks (The Center for Food Security & Public Health, 2017). Even in the pre-antibiotic era, only 1.5% of fatalities were observed (Zander & Farver, 2018). Q fever can be found throughout the world, but the epidemiological features of the disease differ depending on the geographic region considered (Eldin et al., 2017). Thus, fever has a low mortality rate, even with a combination of symptoms.
Agent
The agent of Q fever is the bacterium Coxiella burnetii, which affects both animals and humans. The bacterium was first described in 1937 in Australia among slaughterhouse workers and was “identified as the causative agent of Q Fever” (Eldin et al., 2017). Coxiella burnetii is a strictly intracellular gram-negative bacterium, which infects various organisms from arthropods to humans. (Eldin et al., 2017). The clinical presentation of the disease depends on the virulence of the bacterium and the individual risk factors of each patient.
Condition
Q fever in animals is asymptomatic; in humans, it causes an acute or chronic infection. The acute form, characterized by the appearance of flu symptoms, is observed in 40% of patients; 2-5% get complications in the form of meningitis, hepatitis, pneumonia, and myocarditis (Sellen et al., 2016). The chronic form can develop from several months to several years and is characterized by the appearance of endocarditis, vascular and osteoarticular infections, chronic hepatitis, and pulmonary infections (Graves et al., 2018). Thus, in other cases, the disease in humans is asymptomatic.
Age, Gender, Ethnic Group, Nativity
People of all ages are vulnerable to Q Fever; however, there is evidence that most of the infected are in the age group of 40-69 years (Graves et al., 2018). The ratio of men and women infected with Q fever from 2008 until 2015 is approximately 77.7% to 22.2%, respectively (Baymakova et al., 2019). There is no data on the prevalence of fever among specific ethnic groups as well as nativity since Q Fever can occur worldwide. There is also no statistical information about the marital status of the infected.
Other Characteristics
The spread of fever infection is influenced by livestock. Thus, the disease’s geographical spread around the world is characterized by distances to farms (Clark & Soares Magalhaes, 2018). The proximity to farms and livestock increases the risk of infection and disease outbreaks. Fever is directly related to the social status of the infected; mostly, spread occurs in rural, underdeveloped areas (Martinov, 2017). There is no detailed data on the income and housing of infected people. Most of the sick work on farms, as the infection comes from livestock (Martinov, 2017). Information about their education is also not presented in the scientific literature.
Seasoning
Q fever temporal variation is associated with the “lambing and calving period of goats or sheep” (Clark & Soares Magalhaes, 2018, p. 5). Outbreaks are recorded during lambing periods in densely populated areas. The smallest number of infections occurs in November and is about 60 cases, while from April to June, the numbers rise to 200-220 cases (Centers of Disease Control and Prevention, 2019). Thus, the largest number of infections is recorded in the spring and early summer, with the peak incidence in April and May.
Further Research
Q fever is currently poorly understood, especially in hard-to-reach regions, such as Africa. An outbreak in the Netherlands provided researchers with extensive data on the causes and modes of infection (Salifu et al., 2019). However, conditions vary widely from continent to continent, requiring attention to more detailed studies in Africa and other less developed countries. Thus, it is necessary to extrapolate information to wider regions, as well as to integrate molecular and serological studies.
Biblical Rationale
Although Q Fever is not specifically mentioned in the Bible, infectious diseases in livestock are described which can be transmitted to humans. Diseases are included in the term murrain and can be found in the Bible in three quotations (Earle, 1989):
- “Behold, the hand of the LORD is upon thy cattle which is in the field, upon the horses, upon the asses, upon the camels, upon the oxen, and upon the sheep: there shall be a very grievous murrain” (The Holy Bible, 2004, p. 33).
- “And the LORD did that thing on the morrow, and all the cattle of Egypt died: but of the cattle of the children of Israel died not one” (The Holy Bible, 2004, p. 33).
- “He made a way to his anger; he spared not their soul from death, but gave their life over to the pestilence” (The Holy Bible, 2004, p. 293).
Key Points
- Q Fever has a low morbidity rate
- Spread among farmworkers
- The research is complicated due to the lack of data from remote regions
- Further study can help to prevent outbreaks
References
Akamine, C., Perez, M., Lee, J. H., & Ing, M. (2019). Q fever in Southern California: A case series of 20 patients from a VA Medical Center. The American Journal of Tropical Medicine and Hygiene, 101(1), 33-39.
Baymakova, M., Popov, G., Andonova, R., Kovaleva, V., Dikov, I., & Plochev, K. (2019). Fever of unknown origin and Q-fever: A case series in a Bulgarian hospital. Caspian Journal of Internal Medicine, 10(1), 102-106.
Berger, S. (2020). Q fever: Global status. Gideon Informatics Inc.
Bok, J., Hogerwerf, L., Germeraad, E., Roest, H., Faye-Joof, T., Jeng, M., Nwakanma, D., Secka, A., Stegeman, A., Goossens, B., Wegmuller, R., van der Sande, M., van der Hoek, W., & Secka, O. (2017). Coxiella burnetii (Q fever) prevalence in associated populations of humans and small ruminants in The Gambia. Tropical Medicine and International Health, 22(3), 323-331.
Centers of Disease Control and Prevention. (2019). Q Fever: Epidemiology and statistics.
Clark, N. J., & Soares Magalhães, R. J. (2018). Airborne geographical dispersal of Q fever from livestock holdings to human communities: a systematic review and critical appraisal of evidence. BMC Infectious Diseases, 18(1), 218-227.
Earle, D. P. (1989). A biblical disease updated. Transactions of the American Climatological Association, 100, 132-141.
Eldin, C., Mélenotte, C., Mediannikov, O., Chigo, E., Million, M., Edouard, S., Mege, J., Maurin, M., & Raoult, D. (2017). From Q fever to Coxiella burnetii infection: A paradigm change. Clinical Microbiology Reviews, 30, 115-190.
Graves, S., Massey, P., Bosward, K., van den Berg, D., & Hutchinson, P. (2018). Q fever: A rural disease with potential urban consequences. Australian Journal of General Practice, 47(3), 5555.
Kaufman, H., Chen, Z., Radcliff, J., Batterman, H., & Leake, J. (2018). Q fever: An under-reported reportable communicable disease. Epidemiology and Infection, 146, 1240-1244. Web.
Martinov, S. (2017). Q fever (1st ed.). River Publishers.
Salifu, S., Adamu Bukaru, A., Frangoulidis, D., & Wheelhouse, N. (2019). Current perspectives on the transmission of Q fever: highlighting the need for a systematic molecular approach for a neglected disease in Africa. Acta Tropica, 193, 99-105.
Sellen, E., Norris, J., Dhand, N., Heller, J., Hayes, L., Gidding, H., Willaby, H., Wood, N., & Bosward, K. (2016). Q fever knowledge, attitudes and vaccination status of Australia’s veterinary workforce in 2014. Plos One, 11(1), 1-18.
The Holy Bible: King James edition. (2004). Hendrickson Publishers.
The Center for Food Security & Public Health. (2017). Q fever.
Zander, D., & Farver, C. (Eds.). (2018). Pulmonary pathology. Elsevier.