UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Treatment and prevention of Q fever

Author
Didier Raoult, MD, PhD
Section Editors
Daniel J Sexton, MD
Morven S Edwards, MD
Deputy Editor
Jennifer Mitty, MD, MPH

INTRODUCTION

Q fever is a widespread zoonotic infection caused by the pathogen, Coxiella burnetii [1]. The designation Q fever (from Query) was made in 1935 following an outbreak of a febrile illness in slaughterhouse workers in Queensland, Australia. The disease is reportable in the United States, and its agent, C. burnetii, is a potential agent of bioterrorism [2]. (See "Identifying and managing casualties of biological terrorism".)

The treatment and prevention of Q fever will be reviewed here. The microbiology, epidemiology, clinical manifestations, and diagnosis of Q fever, as well as Q fever endocarditis, are discussed separately. (See "Microbiology and epidemiology of Q fever" and "Clinical manifestations and diagnosis of Q fever" and "Q fever endocarditis".)

APPROACH TO TREATMENT

The approach to treatment for Q fever depends primarily upon the presence of acute or persistent localized disease [3]. Acute and persistent infection can be distinguished through their clinical presentation and the results of serologic testing. A detailed discussion of the clinical manifestations and diagnosis of Q fever is found elsewhere. (See "Clinical manifestations and diagnosis of Q fever".)

In the past, the clinical manifestations of Q fever were typically divided into acute Q fever and chronic Q fever. However, patients were sometimes diagnosed with chronic Q fever without a clear clinical focus of disease. This has led to controversy over how to define chronic Q fever. Thus, rather than use the term "chronic Q fever" to describe a clinical condition, we prefer to describe the specific disease manifestations (table 1). (See "Clinical manifestations and diagnosis of Q fever", section on 'Clinical manifestations'.)

The treatment of choice for most patients is doxycycline. However, the duration of treatment and the need for additional agents and/or surgery are based upon the specific disease manifestation, as well as the patient’s underlying comorbidities. As examples:

                      

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Thu Apr 28 00:00:00 GMT+00:00 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Raoult D, Marrie T. Q fever. Clin Infect Dis 1995; 20:489.
  2. Raoult D, Marrie T, Mege J. Natural history and pathophysiology of Q fever. Lancet Infect Dis 2005; 5:219.
  3. Raoult D. Chronic Q fever: expert opinion versus literature analysis and consensus. J Infect 2012; 65:102.
  4. Anderson A, Bijlmer H, Fournier PE, et al. Diagnosis and management of Q fever--United States, 2013: recommendations from CDC and the Q Fever Working Group. MMWR Recomm Rep 2013; 62:1.
  5. Million M, Roblot F, Carles D, et al. Reevaluation of the risk of fetal death and malformation after Q Fever. Clin Infect Dis 2014; 59:256.
  6. Levy P, Raoult D, Razongles JJ. Q-fever and autoimmunity. Eur J Epidemiol 1989; 5:447.
  7. POWELL OW, KENNEDY KP, McIVER M, SILVERSTONE H. Tetracycline in the treatment of "Q" fever. Australas Ann Med 1962; 11:184.
  8. Fenollar F, Fournier PE, Carrieri MP, et al. Risks factors and prevention of Q fever endocarditis. Clin Infect Dis 2001; 33:312.
  9. Gikas A, Spyridaki I, Scoulica E, et al. In vitro susceptibility of Coxiella burnetii to linezolid in comparison with its susceptibilities to quinolones, doxycycline, and clarithromycin. Antimicrob Agents Chemother 2001; 45:3276.
  10. Gikas A, Kofteridis DP, Manios A, et al. Newer macrolides as empiric treatment for acute Q fever infection. Antimicrob Agents Chemother 2001; 45:3644.
  11. Boulos A, Rolain JM, Maurin M, Raoult D. Measurement of the antibiotic susceptibility of Coxiella burnetii using real time PCR. Int J Antimicrob Agents 2004; 23:169.
  12. American Academy of Pediatrics. Q fever. In: Pickering LK, Baker CJ, Kimberlin DW, Long SS, eds. Red Book: 2012 Report of the Committee on Infectious Diseases. Elk Grove Village, IL: American Academy of Pediatrics; 2012:599-600
  13. American Academy of Pediatrics. Antimicrobial agents and related therapy. In: Red Book: 2015 Report of the Committee on Infectious Diseases, 30th ed, Kimberlin DW, Brady MT, Jackson MA, Long SS. (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2015. p.871.
  14. Todd SR, Dahlgren FS, Traeger MS, et al. No visible dental staining in children treated with doxycycline for suspected Rocky Mountain Spotted Fever. J Pediatr 2015; 166:1246.
  15. Cross R, Ling C, Day NP, et al. Revisiting doxycycline in pregnancy and early childhood--time to rebuild its reputation? Expert Opin Drug Saf 2016; 15:367.
  16. Million M, Raoult D. Recent advances in the study of Q fever epidemiology, diagnosis and management. J Infect 2015; 71 Suppl 1:S2.
  17. Carcopino X, Raoult D, Bretelle F, et al. Managing Q fever during pregnancy: the benefits of long-term cotrimoxazole therapy. Clin Infect Dis 2007; 45:548.
  18. Million M, Walter G, Thuny F, et al. Evolution from acute Q fever to endocarditis is associated with underlying valvulopathy and age and can be prevented by prolonged antibiotic treatment. Clin Infect Dis 2013; 57:836.
  19. Wielders CC, Morroy G, Wever PC, et al. Strategies for early detection of chronic Q-fever: a systematic review. Eur J Clin Invest 2013; 43:616.
  20. Brouqui P, Dupont HT, Drancourt M, et al. Chronic Q fever. Ninety-two cases from France, including 27 cases without endocarditis. Arch Intern Med 1993; 153:642.
  21. Maurin M, Benoliel AM, Bongrand P, Raoult D. Phagolysosomal alkalinization and the bactericidal effect of antibiotics: the Coxiella burnetii paradigm. J Infect Dis 1992; 166:1097.
  22. Maurin M, Raoult D. Phagolysosomal alkalinization and intracellular killing of Staphylococcus aureus by amikacin. J Infect Dis 1994; 169:330.
  23. Maurin M, Benoliel AM, Bongrand P, Raoult D. Phagolysosomes of Coxiella burnetii-infected cell lines maintain an acidic pH during persistent infection. Infect Immun 1992; 60:5013.
  24. Raoult D, Houpikian P, Tissot Dupont H, et al. Treatment of Q fever endocarditis: comparison of 2 regimens containing doxycycline and ofloxacin or hydroxychloroquine. Arch Intern Med 1999; 159:167.
  25. Botelho-Nevers E, Fournier PE, Richet H, et al. Coxiella burnetii infection of aortic aneurysms or vascular grafts: report of 30 new cases and evaluation of outcome. Eur J Clin Microbiol Infect Dis 2007; 26:635.
  26. Keijmel SP, Saxe J, van der Meer JW, et al. A comparison of patients with Q fever fatigue syndrome and patients with chronic fatigue syndrome with a focus on inflammatory markers and possible fatigue perpetuating cognitions and behaviour. J Psychosom Res 2015; 79:295.
  27. Keijmel SP, Delsing CE, Sprong T, et al. The Qure study: Q fever fatigue syndrome--response to treatment; a randomized placebo-controlled trial. BMC Infect Dis 2013; 13:157.
  28. Ackland JR, Worswick DA, Marmion BP. Vaccine prophylaxis of Q fever. A follow-up study of the efficacy of Q-Vax (CSL) 1985-1990. Med J Aust 1994; 160:704.
  29. Waag DM, England MJ, Tammariello RF, et al. Comparative efficacy and immunogenicity of Q fever chloroform:methanol residue (CMR) and phase I cellular (Q-Vax) vaccines in cynomolgus monkeys challenged by aerosol. Vaccine 2002; 20:2623.
  30. Fries LF, Waag DM, Williams JC. Safety and immunogenicity in human volunteers of a chloroform-methanol residue vaccine for Q fever. Infect Immun 1993; 61:1251.
  31. Parker NR, Barralet JH, Bell AM. Q fever. Lancet 2006; 367:679.
  32. www.cdc.gov/ncidod/dvrd/qfever/index.htm#prevention1 (Accessed on March 03, 2006).