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:
- Raoult D, Marrie T. Q fever. Clin Infect Dis 1995; 20:489.
- Raoult D, Marrie T, Mege J. Natural history and pathophysiology of Q fever. Lancet Infect Dis 2005; 5:219.
- Raoult D. Chronic Q fever: expert opinion versus literature analysis and consensus. J Infect 2012; 65:102.
- 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.
- 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.
- Levy P, Raoult D, Razongles JJ. Q-fever and autoimmunity. Eur J Epidemiol 1989; 5:447.
- POWELL OW, KENNEDY KP, McIVER M, SILVERSTONE H. Tetracycline in the treatment of "Q" fever. Australas Ann Med 1962; 11:184.
- Fenollar F, Fournier PE, Carrieri MP, et al. Risks factors and prevention of Q fever endocarditis. Clin Infect Dis 2001; 33:312.
- 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.
- Gikas A, Kofteridis DP, Manios A, et al. Newer macrolides as empiric treatment for acute Q fever infection. Antimicrob Agents Chemother 2001; 45:3644.
- 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.
- 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
- 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.
- 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.
- 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.
- Million M, Raoult D. Recent advances in the study of Q fever epidemiology, diagnosis and management. J Infect 2015; 71 Suppl 1:S2.
- 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.
- 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.
- 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.
- 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.
- 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.
- Maurin M, Raoult D. Phagolysosomal alkalinization and intracellular killing of Staphylococcus aureus by amikacin. J Infect Dis 1994; 169:330.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- Parker NR, Barralet JH, Bell AM. Q fever. Lancet 2006; 367:679.
- 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