Q fever and Rickettsial Infections Causing Chronic Fatigue Syndrome (CFS)

Q-fever is well recognised as causing a chronic infection is approximately 20% of patients who have had an acute infection. Recently, our laboratory has discovered a rickettsial agent, which is associated with CFS patients.

Chronic Q-fever

This disease manifests in a number of ways. The most serious is endocarditis, while the most common is post Q fever fatigue syndrome (QFS). Endocarditis may appear between 1-5 years following the acute infection and has a predisposition for patients with pre-existing valvular heart disease. Symptoms of QFS may include; incapacitating fatigue, headache, nausea, night sweats, muscle and joint pain, loss of concentration and mental acuity. QFS may last for several years and may be due to the immune system reacting in an unusual way to the bacterium that causes Q-fever.

Chronic rickettsial infections

Although anecdotal evidence of rickettsial infections causing CFS has been around for several years, recent scientific evidence has started to support this observation. Our laboratory has detected rickettsial agents in some patients with CFS. Although cases of Brill-Zinsser disease, a recurrent form of epidemic typhus (Rickettsia prowazekii), are well documented several years following the initial infection, this agent is not currently present in Australia. Cases of persistent scrub typhus (Orientia tsutsugamushi) infections in humans and rickettsial spotted fever infections in dogs have also been documented. Rickettsial associated CFS appears to include the following symptoms; chronic pain (back, muscles and joints), fibromyalgia, debilitating fatigue and depression.


Our laboratory is able to perform a number of tests to help with the diagnosis of these syndromes. Doctors can request either Q-fever or rickettsial serology, PCR and culture. These test results may help with the management of the patient, by demonstrating past (or current) infection with the bacteria causing Q-fever or rickettsial disease. Alternatively, they may exclude this possibility.

Medical Consultation

Doctors are invited to discuss their patients diagnosis with Dr Stephen Graves. Patients should seek advice from their regular medical practitioner.


Australian Rickettsial