Ask the Flight Surgeon / By MAJ (Dr.) Sara B. Snyder: Q: I am about to deploy to the Middle East, and I heard that there was a risk of getting something called Q fever. What exactly is Q fever, and should I be concerned?
Dr. (Col.) Michael Zapor, a staph infectious diseases physician at Walter Reed National Military Medical Center, treats Afghans during his tour there as a battalion surgeon with the 82nd Airborne Division. / army.mil
FS: Coxiella burnetii, the bacteria that causes Q fever, is found worldwide and often finds a host in farm animals, especially goats, cattle, and sheep. Though those who work in animal husbandry are at higher risk for being exposed to C. burnetti, livestock farming is not a requirement for the transmission of Q fever to humans. C. burnetti bacteria is highly infectious and hardy in the environment. It has the potential to be carried downwind as far as six miles from its source. Because of this inhalational hazard, there are hundreds of documented cases of Q fever infections among American and British military personnel deployed in Iraq and Afghanistan. In the Aviation community, dusts containing the bacterium can be aerosolized by rotor wash and inhaled unknowingly, especially in the arid environments of the Middle East. These dusts can be contaminated by animal feces, urine or birthing products.
Ingestion is the second most common route of bacterial exposure. For this reason, you should avoid consuming raw or unpasteurized milk products, such as soft cheeses, when eating off the local economy overseas. The purchase of wool clothing or bedding products should also be avoided due to the ability of the bacterial to aerosolize from the cloth. Agricultural surroundings, combined with the hot, dry, and dusty environment of the Middle East, promote the most common routes of C. burnetti exposure. The greatest risk factors for Q fever chronicity remain in individuals with pre-existing heart disease, pregnant women, and immune compromised individuals. The risk for the development of chronic infection in otherwise healthy adults remains unknown.
Q fever is often confused with the flu because it can produce similar nonspecific symptoms like fatigue, fever, chills, muscle aches, cough, headaches, and night sweats. In fact, most mild to moderate cases of infection with Q fever may go undiagnosed and unrecognized by the individual. Approximately one-half of individuals that contract Q fever clear the infection on their own. However, a Q fever infection may require medical attention if it does not clear or progresses to more severe symptoms such as pneumonia or hepatitis. Because the clinical symptoms of acute Q fever are nonspecific and oftentimes asymptomatic, the disease can progress undiagnosed to the chronic form, where most of the grave morbidity and mortality complications from infection arise. The most common serious complication from chronic Q fever is endocarditis, or inflammation of the inner lining of the heart chambers and valves, which left untreated can lead to fatality. It should be noted that Q fever is especially concerning in pregnant women as it may result in miscarriage, premature birth, or low birth weight during pregnancy. It is therefore important for women with a past medical history of a failed pregnancy and occupational exposure to consider serologic testing to rule out C. burnetti infection.
Diagnosing cases of Q fever requires your aeromedical provider to have the necessary clinical suspicion and to perform a careful occupational and travel history. For both acute and chronic Q fever infection, a blood test with the C. burnetti Antibody Panel can provide essential clues as to whether the infection is present. It is recommended that anyone with a diagnosis of acute Q fever be monitored with blood testing and clinical follow up for approximately two years to rule out the possibility of a chronic, or persistent, infection. There are no Q fever vaccines currently available in the United States. Generally, the treatment for acute cases of Q fever in adults consists of a broad-spectrum antibiotic, such as doxycycline, for approximately fourteen days. For cases of acute Q fever with preexisting heart disease, such as valvular problems, treatment duration is much longer, approximately twelve to eighteen months. Cases of chronic Q fever require individualized treatment plans based on the severity of disease. Infectious disease consultation is recommended for all cases of acute and chronic Q fever. In an otherwise healthy Aviator, hospitalized for a flu-like illness or fever of unknown origin, Q fever should be considered, particularly in the setting of probable occupational exposure.
Fly safe!
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If you have a question you would like addressed, email it to This email address is being protected from spambots. You need JavaScript enabled to view it.; we’ll try to address it in the future. See your unit flight surgeon for your personal health issues.The views and opinions offered are those of the author and researchers and should not be construed as an official Department of the Army position unless otherwise stated.
MAJ (Dr.) Sarah B. Snyder, D.O., FS is a flight surgeon at the School of Army Aviation Medicine, Fort Rucker, AL.
