Q fever, Chronic

• Persistent, unexplained fever (often low-grade)
• Profound fatigue and malaise
• Unintended weight loss and night sweats
• Symptoms related to affected organs, most commonly *endocarditis* (e.g., new or changing heart murmurs, heart failure symptoms)
• Vascular infection symptoms (e.g., pain, swelling, aneurysm complications)

Chronic Q fever is primarily transmitted through the inhalation of aerosols containing *Coxiella burnetii*, which are shed by infected animals, particularly during birthing. Direct contact with contaminated animal products like placenta, amniotic fluid, or wool can also lead to infection. Ingestion of unpasteurized milk is a less common route, and human-to-human transmission is exceedingly rare.

• Avoid exposure to livestock, especially birthing animals and their products (placenta, amniotic fluid).
• Use personal protective equipment (PPE) like masks, gloves, and protective clothing when working with high-risk animals or contaminated materials.
• Practice good hygiene, including thorough handwashing after animal contact.
• Consider vaccination with Q-VAX (where available) for individuals in high-risk occupations.