Q fever: still a mysterious disease

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Abstract
Q fever remains an incompletely understood disease (the Q is for Query). It is caused by a zoonotic agent, C. burnetii, that is widely distributed in animals.1 It can give rise to chronic infections in certain patients: chronic endocarditis, osteomyelitis, and infections of vascular aneurysms and prosthetics have all been documented by culture. When infection occurs during pregnancy, abortion may result, and chronic uterine infection, associated with recurrent miscarriages, may follow acute infection.2 In patients with valvular lesions and those with cancer, Q fever can lead to chronic endocarditis within months to years.3 Moreover, in animals that have recovered from C. burnetii, immunosuppression can induce a bacteraemic relapse.4, 5 This demonstrates that any resistance to infection following recovery is non‐immune, and chronic carriage may be common. Thus C. burnetii may be involved in the aetiology of chronic illnesses, such as chronic fatigue and artherosclerosis, where the causative agent is unknown.

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