Treatment of Q fever

Raoult, Didier

doi:10.1128/aac.37.9.1733

Cited by 131 publications

(94 citation statements)

References 33 publications

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“…ALP alkaline phosphatase; ALT alanine aminotransferase; AST aspartate aminotransferase; CK creatine kinase; CRP C reactive protein; ESR erythrocyte sedimentation rate; GGT gamma-glutamyltransferase; LDH lactate dehydrogenase. In the present study, treatment was found to have been adequate, according to field literature, 1,2,67,68 in 65.6% of the cases (n=21): 19 received doxycycline 100 mg twice daily (bid) for at least 14 days and two patients were treated with ciprofloxacin, either 500 mg or 750 mg bid for 18 and 21 days, respectively. The other 11 cases received inadequate treatment: five patients (15.6%) received the wrong antibiotic (either beta-lactam, beta-lactam combined with aminoglycoside, macrolide or carbapenem and in one case only symptomatic treatment) and six patients (18.8%) received the correct antibiotic but for insufficient periods (less than 14 days).…”

Section: Clinical Datamentioning

confidence: 91%

“…1,67 In case of intolerance to doxycycline (especially gastric intolerance) or in the case of meningoencephalitis, fluoroquinolones are preferred. 2,68 Treatment of acute Q fever with doxycycline is only efficient during the symptomatic phase, leading to a reduced period of fever. 22 Treating asymptomatic Q fever patients or treating them for periods of less than 14 days are practices commonly found in this and other studies; 69 however, such treatments are neither considered clinically necessary nor are they suggested in review articles about this disease.…”

Section: Discussionmentioning

confidence: 99%

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cute Q fever in Portugal. Epidemiological and clinical features of 32 hospitalized patients

Palmela¹,

Badura²,

Valadas³

2012

GERMS

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Section: Clinical Datamentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

cute Q fever in Portugal. Epidemiological and clinical features of 32 hospitalized patients

Palmela¹,

Badura²,

Valadas³

2012

GERMS

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“…First, given the insidious nature of the disease, patients should have phase I serology checked at regular intervals to ensure efficacy of the regimen. A phase I immunoglobulin G titre of less than 1:200 has been proposed as the main criterion for a clinical cure (36). Similarly, due to the high relapse rate after discontinuation of antibiotics, patients should be followed closely with clinical assessment, echocardiography and laboratory investigation, including phase I serology, at regular intervals (4).…”

Section: Discussionmentioning

confidence: 99%

Q fever endocarditis: A case report and review of the literature

Deyell

Chiu²,

Ross

et al. 2006

Canadian Journal of Cardiology

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E ndocarditis is the most common presentation of chronic Q fever, a zoonosis caused by the obligate intracellular bacteria Coxiella burnetii. Commonly believed to be a rare disorder, it has been estimated to account for up to 5% of all endocarditis cases worldwide (1-3). It occurs almost exclusively in patients who have pre-existing valvular disease or who are immunocompromised (4). Unlike typical cases of endocarditis, the clinical presentation of chronic Q fever is often nonspecific. Furthermore, specialized techniques are required for identification of the organism, and echocardiographic evidence of infection is frequently absent (5). Without prompt recognition and appropriate antimicrobial therapy, the course of Q fever endocarditis is severe and potentially fatal. The following case demonstrates many of the clinical features of chronic Q fever and highlights the difficulty of obtaining the diagnosis. CASE PRESENTATIONA 31-year-old Caucasian man presented to a walk-in clinic complaining of progressive, exertional shortness of breath. He had moved to Calgary, Alberta, from Nova Scotia, where he had worked on a dairy farm, two years prior. Due to pre-existing congenital valvular heart disease, he was referred to the Adult Congenital Cardiology Clinic at the University of Calgary (Calgary, Alberta). The patient could barely climb one flight of stairs without significant shortness of breath, and had developed orthopnea and paroxysmal nocturnal dyspnea. He described occasional palpitations, but denied any syncopal episodes, chest discomfort or peripheral edema. There were no symptoms suggestive of systemic infection.Of note, the patient had been diagnosed with congenital aortic stenosis at the age of eight months and underwent open aortic valvulotomy. The patient was found to have a trileaflet valve with significant fusion of the leaflets. Catheterization at the age of 10 years revealed a peak residual gradient of 25 mmHg across the aortic valve with mild aortic insufficiency. Echocardiograms at the ages of 18 and 22 years demonstrated peak gradients of 37 mmHg and 56 mmHg, respectively, moderate aortic insufficiency and preserved left ventricular function. The patient had no cardiology follow-up after the age of 22 years.Physical examination revealed a blood pressure of 110/50 mmHg, a heart rate of 82 beats/min and a normal The case of a 31-year-old man from Alberta diagnosed with Q fever endocarditis is presented. To the authors' knowledge, this is the first case of Q fever endocarditis diagnosed in the province of Alberta. The patient had undergone open valvulotomy for congenital aortic stenosis as an infant. He presented with congestive heart failure secondary to severe aortic regurgitation and underwent mechanical aortic valve replacement. Early failure of the mechanical prosthesis and numerous laboratory abnormalities prompted an investigation for endocarditis, which was initially negative. Markedly positive serology eventually established the diagnosis of chronic Q fever. The patient subsequently underwent...

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“…Monotherapy with each of these drugs may be effective in reducing the symptoms associated with chronic Q fever, but relapses are frequent upon cessation of antibiotics, prompting the development of combination regimens (17,30). Although the combination of doxycycline and rifampin appears to be more effective than doxycycline alone, the use of rifampin is limited by drug-related interactions, especially with anticoagulant agents, which are often prescribed to patients with cardiac valve defects or prosthetic valves (28).…”

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confidence: 99%

Chronic Q Fever in the United States

Karakousis¹,

Trucksis

Dumler

2006

J Clin Microbiol

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Infections due to Coxiella burnetii, the causative agent of Q fever, are uncommon in the United States. Cases of chronic Q fever are extremely rare and most often manifest as culture-negative endocarditis in patients with underlying valvular heart disease. We describe a 31-year-old farmer from West Virginia with a history of congenital heart disease and recurrent fevers for 14 months who was diagnosed with Q fever endocarditis based on an extremely high antibody titer against Coxiella burnetii phase I antigen. Despite treatment with doxycycline, he continued to have markedly elevated Coxiella burnetii phase I antibody titers for 10 years after the initial diagnosis. To our knowledge, this case represents the longest follow-up period for a patient with chronic Q fever in the United States. We review all cases of chronic Q fever reported in the United States and discuss important issues pertaining to epidemiology, diagnosis, and management of this disease. CASE REPORTA 31-year-old farmer from West Virginia was admitted in June 1995 because of recurrent episodes of fever as high as 39°C, night sweats, paroxysmal coughing, chest pressure, decreased appetite, fatigue, and an 11-kg involuntary weight loss over the preceding 14 months. He had been treated several times for presumed bronchitis with various antibiotics, but his complaints had worsened since December 1994. His past medical history was significant for congenital heart disease, including dextrocardia, a double-outlet right ventricle, a ventricular septal defect, and severe pulmonary stenosis. As an infant, he had undergone operative placement of a right Blalock-Taussig shunt, and at age 12, he underwent surgery for closure of a ventricular septal defect and placement of a conduit between the right ventricle and pulmonary artery. At age 26, he underwent surgery for replacement with a 22-mm Hancock conduit. He participated in birthing his calves, one of which was stillborn around the time of the onset of his illness. He was treated empirically with penicillin, gentamicin, and vancomycin, and his fevers resolved.On physical examination, he was a thin, chronically ill-appearing white male. His vital signs were within normal limits, and he was afebrile. Cardiac examination revealed a grade 3/6 harsh systolic ejection murmur heard maximally at the right upper sternal border without radiation. The chest examination was normal. There was no hepatosplenomegaly, enlarged lymph nodes, or peripheral stigmata of endocarditis. Laboratory studies revealed the following results: hematocrit level was 41%; white blood cell count was 7.3 ϫ 10 9 white blood cells/ liter, with a differential cell count of 35% segmented neutrophils, 5% bands, and 54% lymphocytes; platelets were aggregated and uncountable; electrolyte panel and urinalysis were normal; erythrocyte sedimentation rate was 34 mm/h; and alkaline phosphatase, aspartate aminotransferase, and alanine aminotransferase levels were elevated at 198 U/liter, 244 U/ liter, and 196 U/liter, respectively. Serologies for hepatiti...

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Treatment of Q fever

Cited by 131 publications

References 33 publications

cute Q fever in Portugal. Epidemiological and clinical features of 32 hospitalized patients

cute Q fever in Portugal. Epidemiological and clinical features of 32 hospitalized patients

Q fever endocarditis: A case report and review of the literature

Chronic Q Fever in the United States

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