Antimicrobial therapies for Q fever

Abstract

Summary Q fever is caused by the bacterium Coxiella burnetii and has both acute and chronic forms. The acute disease is a febrile illness often with headache and myalgia that can be self-limiting whereas the chronic disease typically presents as endocarditis and can be life threatening. The normal therapy for the acute disease is a two week course of doxycycline, whereas chronic disease requires 18-24 months of doxycycline in combination with hydroxychloroquine. Alternative treatments are used for pregnant women, young children, and those who cannot tolerate doxycycline. Doxycycline resistance is rare but has been reported. Co-trimoxazole is a currently recommended alternative treatment, but quinolones, rifampin, and newer macrolides may also provide some benefit.

Incidence, associated factors and clinical impact of severe infections in a large, multicentric cohort of patients with systemic lupus erythematosus

“…The alkalinization of phagolysosomes and the inhibition of DNA replication has been posited as one mechanism explaining the protective ability of antimalarials, particularly against intracellular microorganisms such a salmonella, viral agents, etc. (44)(45)(46)(47)(48). Consistent with this, protection against viral infections was observed in our analysis.…”

Acute Pericarditis due to Coxiellaburnetiiinfection, a case report

“…On the other hand, chronic forms are treated with a combination of doxycycline and hydroxychloroquine for at least 1 year [14]. In pregnants, cotrimoxazole has been shown to significantly decrease the risk of adverse consequences for the fetus compared to doxycycline [15].…”

Rapid molecular diagnosis of infective aortic valve endocarditis caused by Coxiella burnetii

“…In this situation treatment should be continued at least for 18 months [2]. Depending on risk for further relapse especially in this patient following valve replacement lifelong therapy could be considered [8]. Long-term clinical and serological follow-up is necessary and cessation of therapy depending on serological markers is possible although proof of a better outcome with this approach has not been shown so far [18].…”

“…b Macroscopic view of the resected aortic root Sequencing of a 494 base pair amplicon resulted in a sequence with 100 % homology to C. burnetii (ATCC VR-615, accession number HM208383). Therapy was therefore re-evaluated on day 12, and changed to doxycycline 100 mg twice and hydroxychloroquine 200 mg three times a day as recommended [2,8]. Finally serological testing detected increased IgG plasma levels (1:65.536 with IFT against Q-fever Phase 1 and 2) proving chronic Q-fever.…”