IT was a Thursday afternoon in August last year when nine-year-old Beau Beissel complained of feeling unwell. His mum, Bec, thinking it was a passing virus, kept him off school. She had no idea of the drama about to unfold – or the incredible battle to get Beau correctly diagnosed.
“You could make a movie out of it,” she says now. “It was that dramatic.”
By Sunday, Beau’s high temperature, sore joints and stomach pains hadn’t eased, so Bec took him to their local hospital in Roma, Queensland. They too diagnosed a virus, said he’d be better in a few days and sent him home.
However, when the little boy developed temperatures of up to 41°C and his stomach pains became excruciating, Bec took him to their GP. Dr Rosie Geraghty was aware the Beissels lived on a cattle farm and as a rural GP with special training she immediately suspected Q fever. By this time Beau was so ill, however, he needed to be in hospital. Dr Geraghty sent him to Emergency with a referral and a pathology form requesting a polymerase chain reaction (PCR) Q fever test. Crucially, that request was ignored.
PCR test critical for diagnosing Q fever
The PCR test is relatively new and not all pathology labs offer it, but it produces an accurate result for Q fever within a few days of the patient becoming unwell. However, the hospital instead conducted a serology test. Although used for many years, the test has a failing. It works by detecting antibodies in the blood produced in response to the Q fever microbe. If a patient’s immune system takes time to respond to that microbe – as often happens – the test will initially come back negative even if the patient does have Q fever.
Sure enough, Beau returned a negative result and as he continued to deteriorate, concerned doctors decided to fly him to Brisbane’s Lady Cilento Children’s Hospital (now known as Queensland Children’s Hospital).
The Lady Cilento Children’s Hospital in Brisbane. Source: Getty Images.
There he had a further 108 blood tests, says Bec. But once again, despite urgent requests by Dr Geraghty and Bec, the PCR Q fever test was not among them. “I was told the test had been done but, again, only the serology test had been done. It was a massive mistake,” Bec says.
The deadly effects of Q fever
By Friday night, Beau’s liver had stopped producing albumin. His stomach was distended and an X-ray of his chest showed his lungs were starting to become wet. His oxygen levels were dropping and his heart rate was going up. His immune system was turning in on itself. “His body was starting to shut down,” Bec says.
As doctors decided to inject a dose of steroids into his drip to shake things up, Dr Geraghty intervened. She called in a favour with a friend at medical testing lab Sullivan Nicolaides Pathology in Brisbane and had Beau’s blood couriered over. It arrived at the lab at 6pm on Friday night. By 10pm she had her result.
“She rang Lady Cilento literally 30 seconds before they were due to put the steroids into Beau,” says Bec.
“They ran into the ward and said: ‘Stop everything! He’s got Q fever!’”
Beau was given doxycycline, the standard antibiotic for Q fever. Within 24 hours, he was feeling better.
“I don’t like to guess what the outcome would’ve been otherwise,” says Bec. “I really feel like we nearly lost him but because it went right to the brink for him, he still has long-lasting issues we’re coping with.
The Beissel family in happier times before Beau got sick. From left: Mother Bec, Beau, sister Maggie and Dad Craig. Source: Supplied.
“He’s been diagnosed with having post-Q fever fatigue syndrome. His knees and ankles become swollen and sore. Because he had the acute form, it took some time for his liver to start functioning properly and his white blood cell count to return to normal.
“They hoped the chronic fatigue would alleviate within six months but we’re getting close to that and he’s still not the little boy he should be. He’s absolutely mad about cricket but in the heat he can only play a little while before he goes white, nearly passes out and feels very unwell. We have to constantly keep an eye on him.”
Hospital admission leads to Q fever awareness
Bec says the hospital has apologised and she wants to make it clear that everyone at Lady Cilento worked really hard to find out what was wrong with Beau. “It was just unfortunate this one crucial test wasn’t done despite the coercing of our GP.”
The one good thing is that after an exchange of emails, Bec has been told the hospital will in future be more open to communication from GPs, especially in rural areas, and the PCR blood test is now part of its own pathology testing unit. Now if a child comes in from a rural area with Q fever symptoms, it’s one of the first things they’ll be tested for.
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A reader of The Farmer magazine, Bec is keen to tell her story in the hope of supporting NSW Farmers’ petition to the federal government to raise awareness of Q fever and the need for a new vaccine that is safe for children and easier to administer. There’s currently no vaccine available for under-15s.
She also wants to see more training in city hospitals so staff are aware of the risks faced by rural children.
“As farmers we know about Q fever. My husband Craig and I have been tested and vaccinated, Unfortunately we weren’t aware of it in kids.”
“We didn’t know of any kids who had got it so we weren’t as vigilant as we could’ve been if we were more informed.”
“We suspect Beau contracted it from a poddy calf because the bacteria is prevalent in the amniotic fluid on newborn calves. We’ve had a few as the kids have grown up and never thought about it – kids being kids, they lie on them, hug them, kiss them, all those sorts of things and as parents we weren’t on guard. Now we are.”
"If you can get a quick diagnosis, Q fever doesn’t have to be a scary thing. It can be easily treated,” Bec says.
Bec also has a daughter Maggie, seven. She worries that with the drought and dust, Q fever is becoming more prevalent. However, although offered the vaccination for her daughter, she turned it down.
“She is only seven and we feel with it not having been tested on under 15s, we’d been through enough. If there were side effects it would be another trauma we’d have to go through unnecessarily. If she was older we’d certainly do it but instead we’ve decided to be hyper vigilant so if she does present with symptoms we will immediately ask for the PCR test.
“If you can get a quick diagnosis, Q fever doesn’t have to be a scary thing. It can be easily treated.”
“Lots of families need kids helping out on farms. If there’s work to be done, you go out and do it as a family. I don’t like to tell Maggie: ‘You can’t go here, it’s high risk’, and I’m not going to stop her world from turning in terms of what we enjoy on our farm, but it will definitely be balanced by our knowledge of getting onto the illness early.”
Expert explains importance of both Q fever tests
Q fever expert Dr Stephen Graves recommends doctors testing for the disease should order both PCR and serology tests.
Dr Graves, who is working on a new vaccine, explains this is because the PCR test becomes positive within a few days of the patient becoming unwell, when the Q fever microbe is circulating in the patient’s blood. However, when the microbe leaves the blood to go into other tissues, the PCR test becomes negative but the patient still has Q fever. It is at this time, however, that the serology test becomes positive.
Thank you for your support!
Support has flooded in for a free Q fever vaccination to help our farmers and rural residents. The Farmer and NSW Farmers set up an official federal government petition pushing for the vaccination, that closed on
14 February reaching over 1000 signatures. The issue will now be debated in the House of Representatives.