Treatment of Chronic Q Fever: Clinical Efficacy and Toxicity of Antibiotic Regimens

Roeden, Sonja E van; Bleeker‐Rovers, Chantal P.; Regt, Marieke J. A. de; Kampschreur, Linda M.; Hoepelman, Andy I. M.; Wever, Peter C.; Oosterheert, Jan Jelrik

doi:10.1093/cid/cix886

Cited by 33 publications

(14 citation statements)

References 17 publications

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“…In this cohort, treatment was extremely heterogeneous in terms of duration, (combination of) antibiotics, switches between antibiotic regimens, etc. In a separate publication, all details with regard to treatment have been described extensively [24].…”

Section: Discussionmentioning

confidence: 99%

Chronic Q fever-related complications and mortality: data from a nationwide cohort

Roeden

Wever

Kampschreur

et al. 2019

Clinical Microbiology and Infection

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Objectives: Chronic infection with Coxiella burnetii (chronic Q fever) can cause life-threatening conditions such as endocarditis, infected vascular prostheses, and infected arterial aneurysms. We aimed to assess prognosis of chronic Q fever patients in terms of complications and mortality. Methods: A large cohort of chronic Q fever patients was assessed to describe complications, overall mortality and chronic Q fever-related mortality. Chronic Q fever-related mortality was expressed as a case fatality rate (number of chronic Q fever-related deaths/number of chronic Q fever patients). Results: Complications occurred in 166 of 439 (38%) chronic Q fever patients: in 61% of proven (153/249), 15% of probable (11/74), and 2% of possible chronic Q fever patients (2/116). Most frequently observed complications were acute aneurysms (14%), heart failure (13%), and non-cardiac abscesses (10%). Overall mortality was 38% (94/249) for proven chronic Q fever patients (median follow-up 3.6 years) and 22% (16/74) for probable chronic Q fever patients (median follow-up 4.7 years). The case fatality rate was 25% for proven (63/249) chronic Q fever patients and 4% for probable (3/74) chronic Q fever patients. Overall survival was significantly lower in patients with complications, compared to those without complications (p <0.001). Conclusions: In chronic Q fever patients, complications occur frequently and contribute to the mortality rate. Patients with proven chronic Q fever have the highest risk of complications and chronic Q feverrelated mortality. Prognosis for patients with possible chronic Q fever is favourable in terms of complications and mortality.

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Section: Discussionmentioning

confidence: 99%

Chronic Q fever-related complications and mortality: data from a nationwide cohort

Roeden

Wever

Kampschreur

et al. 2019

Clinical Microbiology and Infection

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“…We use doxycycline in addition to hydroxychloroquine as a safe and effective first-line treatment for 18e24 months in cases of C. burnetii focalized cardiovascular infection. While the use of quinolone instead of hydroxyplaquenil has been questioned in The Netherlands, the central question remains: why have some patients not been treated, and why has treatment been switched or interrupted [15]?…”

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confidence: 99%

Re: chronic Q-fever-related complications and mortality: data from a nationwide cohort

Melenotte

Million

Raoult

2019

Clinical Microbiology and Infection

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We read with interest the article by van Roeden et al. about the chronic Q fever mortality rate in The Netherlands. We were surprised to observe that the mortality rate reported from The Netherlands was 3.3 times higher than that observed from the French National Reference Center for Q fever [1,2]. In our experience, among the 678 patients with persistent cardiovascular focalized infection diagnosed between 1991 and 2016, 55 died (55/678, 8%): 43 with endocarditis (43/533, 8%) and 16 with a vascular infection (16/145, 11%); among these four had both Coxiella burnetii endocarditis and vascular persistent infection (4/ 49, 8.1%) [2]. The mortality rate was 1.8 (95%CI 1.4e2 .3) per 100 person-years and the 5-year survival for cardiovascular persistent C. burnetii infection was 73%.(see Table 1) In The Netherlands after the 2009e2011 epidemics, of the 439 patients diagnosed with chronic Q fever 118 died (27%), and of these 54 (35%) had a vascular infection, 27 (32%) had endocarditis, and 20 (47%) had both C. burnetii endocarditis and vascular infection. The 5-year survival for proven and probable chronic Q fever was 64% [1]. Persistent C. burnetii cardiovascular infection is a deadly disease if left untreated, but is ultimately curable, so how can the high mortality rate in The Netherlands be explained?

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“…Although this is a highly selected group of individuals, bias based on population characteristics is unlikely. Supportive of this notion is that systemic sclerosis is usually more prevalent among women, while chronic Q fever is not, and systemic sclerosis is generally diagnosed earlier (median of 50 years), compared to chronic Q fever (median of 71 years) . Silica exposure is a known environmental risk factor for the development of systemic sclerosis, and studies indicate that the percentage of previous environmental risk factor exposure is especially high in men with systemic sclerosis …”

Section: Discussionmentioning

confidence: 99%

“…Supportive of this notion is that systemic sclerosis is usually more prevalent among women, while chronic Q fever is not, and systemic sclerosis is generally diagnosed earlier (median of 50 years), 9 compared to chronic Q fever (median of 71 years). 10 Silica exposure is a known environmental risk factor for the development of systemic sclerosis, and studies indicate that the percentage of previous environmental risk factor exposure is especially high in men with systemic sclerosis. 11 It is documented that chronic Q fever infection can trigger autoimmune diseases and other immunological syndromes.…”

Section: Discussionmentioning

confidence: 99%

Chronic Q fever associated with systemic sclerosis

Jansen

Raijmakers

Deuren

et al. 2019

Eur J Clin Investigation

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Background After the Q fever outbreak in the Netherlands between 2007 and 2010, more than 300 patients with chronic Q fever have been identified. Some patients were also diagnosed with systemic sclerosis, a rare immune‐mediated disease. We aimed to increase awareness of concomitant chronic Q fever infection and systemic sclerosis and to give insight into the course of systemic sclerosis during persistent Q fever infection. Materials and methods Chronic Q fever patients were identified after the Dutch Q fever outbreak in 2007‐2010. Systemic sclerosis was diagnosed by a scleroderma expert and patients fulfilled the 2013 Classification Criteria for Systemic Sclerosis. Results Four cases presented with chronic Q fever, persistent Coxiella burnetii infection, shortly preceded or followed by the diagnosis of limited cutaneous systemic sclerosis. The three male patients of 60 years or older developed a relatively mild systemic sclerosis, which did not require immunosuppressive therapy during adequate treatment of the chronic Q fever infection. The 58‐year‐old female patient used immunosuppressives for her newly diagnosed systemic sclerosis at the time she likely developed a chronic Q fever infection. Conclusions In this case series, chronic Q fever preceding systemic sclerosis was associated with a mild course of systemic sclerosis without the necessity of immunosuppressive drugs, while chronic Q fever development due to immunocompromised state was associated with a more deteriorating course of systemic sclerosis.

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Treatment of Chronic Q Fever: Clinical Efficacy and Toxicity of Antibiotic Regimens

Cited by 33 publications

References 17 publications

Chronic Q fever-related complications and mortality: data from a nationwide cohort

Chronic Q fever-related complications and mortality: data from a nationwide cohort

Re: chronic Q-fever-related complications and mortality: data from a nationwide cohort

Chronic Q fever associated with systemic sclerosis

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