Treatment and prevention of Q fever
- Didier Raoult, MD, PhD
Didier Raoult, MD, PhD
- Faculté de Médecine
- Aix Marseille Université
- Section Editors
- Daniel J Sexton, MD
Daniel J Sexton, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Bacterial Infections
- Professor of Medicine
- Duke University Medical Center
- Morven S Edwards, MD
Morven S Edwards, MD
- Section Editor — Pediatric Infectious Diseases
- Professor of Pediatrics
- Baylor College of Medicine
Q fever is a widespread zoonotic infection caused by the pathogen, Coxiella burnetii . 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 . (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 . 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:
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- www.cdc.gov/ncidod/dvrd/qfever/index.htm#prevention1 (Accessed on March 03, 2006).
- APPROACH TO TREATMENT
- ACUTE Q FEVER
- Whom to treat
- Antimicrobial therapy
- - Non-pregnant adults
- - Children
- - Pregnant women
- - Patients with valvulopathy/cardiomyopathy
- Monitoring after treatment
- PERSISTENT LOCALIZED DISEASE
- Antimicrobial regimens for persistent disease
- Disease specific considerations
- - Endocarditis
- - Vascular infection
- - Osteomyelitis, arthritis
- Patient monitoring
- - Adverse effects of therapy
- - Serologic monitoring during treatment
- POST-Q FEVER FATIGUE SYNDROME
- Other measures
- SUMMARY AND RECOMMENDATIONS