Acute Q fever presents with flu-like symptoms, pneumonia, and hepatitis. Chronic Q fever almost always presents with endocarditis and sometimes has musculoskeletal and vascular manifestations.

• Q fever can present with a wide variety of symptoms based on the multiple organs involved. Q fever can be classified as acute or chronic based on the onset of symptoms.^[1][2]
• The incubation period is usually 2 to 3 weeks.

The most common manifestation is flu-like symptoms with abrupt onset of:

• High grade fever: Fever is usually accompanied by chills and sweats^[3]
• Headaches: Retrobulbar and associated with photophobia
• Arthralgias

Usually mild and accidentally discovered on X-rays

• If accompanied by a cough, the cough is dry and nonproductive^[4]
• Dyspnea
• Pleuritic chest pain
• Rarely progresses to acute respiratory distress syndrome (ARDS), which can be life threatening

• Abdominal right upper quadrant pain
• Jaundice
• GI symptoms including nausea, malaise, vomiting, diarrhea, and bloating.

• Myocarditis is rare but is associated with a bad prognosis^[5]
• Chest pain
• Dyspnea
• Palpitation

• Q fever can present with meningoencephalitis
• Headache
• Confusion
• Seizures

• Maculopapular rash
• Diffuse punctate rash
• Erythema nodosum

Most C. brutenii infections during pregnancy are asymptomatic but in rare cases, can cause:

• Intrauterine growth retardation (IUGR)^[6]
• Intrauterine fetal death (IUFD)
• Abortion

Infection during first trimester and placental infection are associated with increased risk of fetal compromise.

Chronic Q fever, characterized by infection that persists for more than 6 months, is uncommon, but is a much more serious disease. Patients who have had acute Q fever may develop the chronic form as soon as 1 year or as long as 20 years after initial infection.^[2]

Endocarditis is the main manifestation of Q fever.

• Characterized by being culture negative endocarditis
• Patients who are predisposed to endocarditis include patients with valvular lesions, prosthetic valves, and immunocompromised patients
• Presents with:
  • Low grade fever
  • Palpitations
  • Dyspnea
  • Embolic manifestations

• Bone and joint infections are common manifestations of chronic Q fever
• Presents with:
  • Low grade fever
  • Bone and joint pain as in chronic osteomyelitis

• Usually in previously affected vessel (e.g. aneurysm)

• Chronic pleural or pericardial effusion and interstitial pulmonary fibrosis present with dyspnea and fatigue

• Liver fibrosis or cirrhosis presents with symptoms of chronic hepatic decompensation (e.g jaundice, abdominal pain and fatigue)

• Presents in up to 10% of chronic Q fever patients

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